Background: Timely implementation of recommended health interventions can improve patient outcomes and cost savings to the healthcare system. Early decision-making in potential cost-effective interventions is crucial in improving resource allocation for future implementation initiatives. Exercise oncology interventions have shown promise in improving the long-term quality-of-life for cancer survivors post-treatment. However, its widespread adoption is hindered by a lag between evidence generation and translation in clinical practice.
Aim: This study reports the application of the Value of Implementation Framework developed by Fenwick et al. to inform decision-making about resource allocation of an exercise oncology intervention for women with gynaecological cancers post-treatment.
Method: A decision-analytic Markov model was built to assess the early cost-effectiveness of the proposed intervention and estimated the expected value for further research and implementation efforts. The decision model was populated using existing literature and a Structured Expert Elicitation (SEE) was conducted with 12 healthcare professionals to bridge the paucity of empirical evidence on three crucial model parameters. Estimated value of perfect information (EVPI) and perfect implementation (EVPIM) were assessed.
Results: Three beta distributions were elicited from the invited experts; QoI1(Mean: 0.362, SD: 0.15), QoI 2 (Mean: 0.457, SD: 0.218), QoI 3 (Mean: 0.446, SD: 0.203). After incorporating SEE-derived evidence in the Markov model, the base case ICER was AU $2,854 per QALY (95% CI: -10,339, 24,297). For a target population around 23,000, the population-level EVPI was AU $9,846.83, while the EVPIM reached approximately AU $95.824 million.
Conclusion: This is the first study that informs policy decisions on the value of implementation for exercise oncology intervention in Australia. Given the low EVPI and high EVPIM, there is limited value in investing further research in this field and investment towards national implementation of the proposed intervention is likely to be worthwhile.