Presentation (CTI)

OBJECTIVES: Surgery for colorectal cancer is associated with substantial postoperative morbidity, poor quality-of-life, and high healthcare costs, leading to interest in strategies to improve recovery. We aimed to estimate the cost-effectiveness of hospital-supervised or home-supported exercise interventions, compared with standard care, in patients undergoing colorectal cancer surgery, from a UK NHS and Personal and Social Services perspective.
METHODS: A within-trial economic evaluation alongside the PREPARE-ABC multi-centre, parallel-group, randomised, controlled trial. Cost-utility and cost-effectiveness analyses were conducted over 12 months using intention-to-treat principles and multiple imputation for missing data, in UK NHS colorectal surgery units across multiple hospitals. Adults aged ≥18 undergoing curative, elective colorectal cancer surgery (ASA I-III) were included (n=645). Participants received either hospital-supervised exercise (cycle ergometer sessions pre-operatively and monthly boosters post-operatively), home-supported exercise (targeted aerobic activity with weekly telephone support pre- and post-operatively), or standard care. Both intervention arms included home-based resistance training and standard care. The primary outcome was incremental cost per quality-adjusted life-year (QALY), using the EQ-5D-5L. Secondary outcomes (based on clinical co-primary outcomes) included cost per additional participant with no post-operative (≤30 days) complications (Clavien-Dindo) and cost per point change in SF-36 Physical Component Score (PCS).
RESULTS: Home-supported exercise was cost-effective compared with standard care, costing £6,760 per additional QALY, and dominated hospital-supervised exercise (less costly, more effective). The probability of home-supported exercise being cost-effective at the £30,000/QALY NICE threshold was 86%. Hospital-supervised exercise was dominated (more costly, less effective) by standard care. For home vs. standard, cost per additional participant without complications was £4,856, and per point change on the SF36 PCS was £91. Findings were consistent in sensitivity analyses.
CONCLUSIONS: Home-supported exercise is a cost-effective addition to standard care for colorectal cancer surgery. Hospital-supervised exercise is not cost-effective in the tested format. These results support integrating structured home-supported exercise into perioperative care pathways.