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

BMC Cancer

Research Article

Lisette van der Molen¹  Frans JM Hilgers²  Lotte MG Steuten³  Valesca P Retèl⁴  Wim H van Harten⁵  Coen RN Rasch⁶  Annemiek AAMHJ L'Ortye⁷ 

[1] Department of Head and Neck Oncology & Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands;Department of Head and Neck Oncology & Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands;Institute of Phonetic Sciences/ACLC, University of Amsterdam, Spuitstraat 210, 1012, Amsterdam, VT, The Netherlands;Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands;Department of Health Technology and Services Research, University of Twente, MB-HTSR, PO Box 217, 7500, Enschede, AE, The Netherlands;Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands;Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands;Department of Health Technology and Services Research, University of Twente, MB-HTSR, PO Box 217, 7500, Enschede, AE, The Netherlands;Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, Amsterdam, CX, The Netherlands;Reade, Centre for Rehabilitation and Rheumatology, location Slotervaart Hospital, Louwesweg 6, 1066, Amsterdam, EC, The Netherlands;

关键词: head and neck cancer;    concomitant chemo-radiotherapy;    cost-effectiveness;    rehabilitation;   

DOI  :  10.1186/1471-2407-11-475

 received in 2011-03-02, accepted in 2011-11-03,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundConcomitant 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.MethodsA 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.ResultsPREP 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 €41,986 and for PREP to €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 €3,200/QALY. At the prevailing threshold of €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.ConclusionsBased 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 €45,906/QALY).

【 授权许可】

Unknown   
© Retèl et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.