Rehabilitation for cancer survivors Cost-effectiveness and budget impact

Introduction: Many cancer survivors suffer from a combination of diseaseand treatment-related morbidities and complaints after primary treatment. There is a growing evidence base for the effectiveness of mono-dimensional rehabilitation interventions; in practice, however, patients often participate in multidimensional programs. This study systematically reviews evidence regarding effectiveness of multidimensional rehabilitation programs for cancer survivors and cost-effectiveness of cancer rehabilitation in general. Methods: The published literature was systematically reviewed. Data were extracted using standardized forms and were summarized narratively. Results: Sixteen effectiveness and six cost-effectiveness studies were included. Multidimensional rehabilitation programmes were found to be effective, but not more effective than mono-dimensional interventions, and not on all outcome measures. Effect sizes for quality of life were in the range of -0.12 (95% confidence interval [CI],-0.45– 0.20) to 0.98 (95% CI, 0.69 –1.29). Incremental cost-effectiveness ratios ranged from -€16,976, indicating cost savings, to €11,057 per quality-adjusted life year. Conclusions: The evidence for multidimensional interventions and the economic impact of rehabilitation studies is scarce and dominated by breast cancer studies. Studies published so far report statistically significant benefits for multidimensional interventions over usual care, most notably for the outcomes fatigue and physical functioning. An additional benefit of multidimensional over mono-dimensional rehabilitation was not found, but this was also sparsely reported on. Available economic evaluations assessed very different rehabilitation interventions. Yet, despite low comparability, all showed favourable cost-effectiveness ratios. Future studies should focus their designs on the comparative effectiveness and cost-effectiveness of multidimensional programs.