Leiden University Scholarly Publications

Persistent URL of this record https://hdl.handle.net/1887/3281691

In Collections

This item can be found in the following collections:

Retel, V.P.; Molen, L. van der; Hilgers, F.J.M.; Rasch, C.R.N.; L'Ortye, A.A.A.M.H.J.; Steuten, L.M.G.; Harten, W.H. van (2011)

A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

Article / Letter to editor
Background: Concomitant chemo-radiotherapy (CCRT) has become an indispensable organ, but not always function preserving treatment modality for advanced head and neck cancer. To prevent/limit the functional side effects of CCRT, special exercise programs are increasingly explored. This study presents cost-effectiveness analyses of a preventive (swallowing) exercise program (PREP) compared to usual care (UC) from a health care perspective.Methods: A Markov decision model of PREP versus UC was developed for CCRT in advanced head and neck cancer. Main outcome variables were tube dependency at one-year and number of post-CCRT hospital admission days. Primary outcome was costs per quality adjusted life years (cost/QALY), with an incremental cost-effectiveness ratio (ICER) as outcome parameter. The Expected Value of Perfect Information (EVPI) was calculated to obtain the value of further research.Results: PREP resulted in less tube dependency (3% and 25%, respectively), and in fewer...Show moreBackground: Concomitant chemo-radiotherapy (CCRT) has become an indispensable organ, but not always function preserving treatment modality for advanced head and neck cancer. To prevent/limit the functional side effects of CCRT, special exercise programs are increasingly explored. This study presents cost-effectiveness analyses of a preventive (swallowing) exercise program (PREP) compared to usual care (UC) from a health care perspective.Methods: A Markov decision model of PREP versus UC was developed for CCRT in advanced head and neck cancer. Main outcome variables were tube dependency at one-year and number of post-CCRT hospital admission days. Primary outcome was costs per quality adjusted life years (cost/QALY), with an incremental cost-effectiveness ratio (ICER) as outcome parameter. The Expected Value of Perfect Information (EVPI) was calculated to obtain the value of further research.Results: PREP resulted in less tube dependency (3% and 25%, respectively), and in fewer hospital admission days than UC (3.2 and 4.5 days respectively). Total costs for UC amounted to (sic)41,986 and for PREP to (sic)42,271. Quality adjusted life years for UC amounted to 0.68 and for PREP to 0.77. Based on costs per QALY, PREP has a higher probability of being cost-effective as long as the willingness to pay threshold for 1 additional QALY is at least (sic)3,200/QALY. At the prevailing threshold of (sic)20,000/QALY the probability for PREP being cost-effective compared to UC was 83%. The EVPI demonstrated potential value in undertaking additional research to reduce the existing decision uncertainty.Conclusions: Based on current evidence, PREP for CCRT in advanced head and neck cancer has the higher probability of being cost-effective when compared to UC. Moreover, the majority of sensitivity analyses produced ICERs that are well below the prevailing willingness to pay threshold for an additional QALY (range from dominance till (sic)45,906/QALY).Show less
head and neck cancer
concomitant chemo-radiotherapy
cost-effectiveness
rehabilitation
All authors
Retel, V.P.; Molen, L. van der; Hilgers, F.J.M.; Rasch, C.R.N.; L'Ortye, A.A.A.M.H.J.; Steuten, L.M.G.; Harten, W.H. van
Date
2011-11-03
Journal
BMC Cancer
Volume
11
DOI
doi:10.1186/1471-2407-11-475