Cost-effectiveness landscape analysis of treatments addressing xerostomia in patients receiving head and neck radiation therapy

Abstract

Head and neck (H&N) radiation therapy (RT) can induce irreversible damage to the salivary glands thereby causing long-term xerostomia or dry mouth in 68%-85% of the patients. Not only does xerostomia significantly impair patients' quality-of-life (QOL) but it also has important medical sequelae, incurring high medical and dental costs. In this article, we review various measures to assess xerostomia and evaluate current and emerging solutions to address this condition in H&N cancer patients. These solutions typically seek to accomplish 1 of the 4 objectives: (1) to protect the salivary glands during RT, (2) to stimulate the remaining gland function, (3) to treat the symptoms of xerostomia, or (4) to regenerate the salivary glands. For each treatment, we assess its mechanisms of action, efficacy, safety, clinical utilization, and cost. We conclude that intensity-modulated radiation therapy is both the most widely used prevention approach and the most cost-effective existing solution and we highlight novel and promising techniques on the cost-effectiveness landscape.

Fig. 1

Treatment gap analysis. Synthesis of the solutions for addressing xerostomia in H&N cancer patients undergoing RT. The solutions are summarized in a graph showing the effectiveness of the solution at treating or preventing xerostomia versus the cost per treatment. The solutions are categorized according to the following criteria: treatment versus prevention and preclinical versus clinical stage. Relative clinical availability is also estimated and represented as bubble size. Highlighted by the dashed circle is the treatment gap, which corresponds to the area of greatest innovation opportunity.