Open Access Highly Accessed Research article

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

Valesca P Retèl1, Lisette van der Molen2, Frans JM Hilgers234, Coen RN Rasch5, Annemiek AAMHJ L'Ortye6, Lotte MG Steuten7 and Wim H van Harten17*

Author Affiliations

1 Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Department of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands

2 Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Department of Head and Neck Oncology & Surgery, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands

3 Institute of Phonetic Sciences/ACLC, University of Amsterdam, Spuitstraat 210, 1012 VT Amsterdam, The Netherlands

4 Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

5 Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Department of Radiation Oncology, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands

6 Reade, Centre for Rehabilitation and Rheumatology, location Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, the Netherlands

7 University of Twente, Department of Health Technology and Services Research, MB-HTSR, PO Box 217, 7500 AE Enschede, the Netherlands

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BMC Cancer 2011, 11:475  doi:10.1186/1471-2407-11-475

Published: 3 November 2011

Abstract

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 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.

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 €45,906/QALY).

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