Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Nov 3:11:475.
doi: 10.1186/1471-2407-11-475.

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

Valesca P Retèl  1 , Lisette van der Molen, Frans J M Hilgers, Coen R N Rasch, Annemiek A A M H J L'Ortye, Lotte M G Steuten, Wim H van Harten
Affiliations
Randomized Controlled Trial

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

Valesca P Retèl et al. BMC Cancer. .

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).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cost-Effectiveness plane; scatter plot showing the mean differences in costs and outcomes from the data using 1000 bootstrap replicates.
Figure 2
Figure 2
Cost-effectiveness Acceptability Curves (CEAC); presenting the probability that the PREP is cost-effective compared with the Usual Care for a range of values of thresholds (ceiling ratios, willingness to pay for one QALY).
Figure 3
Figure 3
CEAC-frontiers; plotting the extent of uncertainty associated with the optimal strategy.
Figure 4
Figure 4
Expected Value of Perfect Information (EVPI) for the population, base case analysis.
See this image and copyright information in PMC

References

    1. Van der Molen L, van Rossum MA, Ackerstaff AH, Smeele LE, Rasch CR, Hilgers FJ. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcomes measures and patient' views. BMC Ear Nose Throat Disord. 2009;9:10. doi: 10.1186/1472-6815-9-10. - DOI - PMC - PubMed
    1. Van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Hilgers FJ. Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol. 2009;266(6):901–2. doi: 10.1007/s00405-008-0845-z. - DOI - PubMed
    1. Ackerstaff AH, Balm AJ, Rasch CR. et al. First year quality-of-life assessment of an intra-arterial (RADPLAT) versus intravenous chemoradiation phase III trial. Head Neck. 2009;31(1):77–84. doi: 10.1002/hed.20937. - DOI - PubMed
    1. Van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ. A Randomized Preventive Rehabilitation Trial in Advanced Head and Neck Cancer Patients Treated with Chemoradiotherapy: Feasibility, Compliance and short-term effects. Dysphagia. 2010. - PMC - PubMed
    1. Kreeft A, Tan IB, van den Brekel MW, Hilgers FJ, Balm AJ. The surgical dilemma of 'functional inoperability' in oral and oropharyngeal cancer: current consensus on operability with regard to functional results. Clin Otolaryngol. 2009;34(2):140–6. doi: 10.1111/j.1749-4486.2009.01884.x. - DOI - PubMed

Publication types

MeSH terms