Hopper C, Niziol C, Sidhu M
National Medical Laser Centre and the Eastman Dental Institute for Oral Health Care Sciences, University College London and University College Hospitals NHS Trust, London WC1E 6Au, UK.
Oral Oncol. 2004 Apr;40(4):372-82. doi: 10.1016/j.oraloncology.2003.09.003.
This study aimed to analyse the cost-effectiveness of Foscan mediated photodynamic therapy (Foscan-PDT) compared with palliative chemotherapy, extensive palliative surgery or 'no treatment' for patients with advanced head and neck cancer in the UK. A computerised cost-effectiveness model was constructed using published effectiveness data and unit costs for each of the treatment arms. Where possible, published resource use data were also used. In the absence of such information, expert opinion informed data input. Robust sensitivity analyses were performed to negate the effect of potential over or underestimation of the costs used for any of the interventions. The primary outcome was incremental cost/life year saved (cost/LYS); the secondary outcomes were incremental cost/overall tumour response and incremental cost/remission. Foscan-PDT was associated with the greatest health gains of all three interventions yielding 129 extra days of life compared with no treatment and extensive palliative surgery and 48 extra days of life compared with four cycles of palliative chemotherapy. The unit cost of Foscan-PDT ( pound 5741) was found to be lower than the unit cost for four cycles of palliative chemotherapy ( pound 9924) and extensive palliative surgery ( pound 16912). Foscan-PDT continued to have a lower unit cost than palliative chemotherapy until the number of chemotherapy cycles was reduced to two or fewer. Reducing the number of cycles would be likely to reduce the health gains associated with chemotherapy. However, even with assumed maintenance of chemotherapy efficacy, Foscan-PDT remained cost-effective versus two or fewer chemotherapy cycles. Compared with three or more cycles of palliative chemotherapy and extensive palliative surgery, Foscan-PDT dominated with a lower unit cost and greater health gains. Compared with giving no treatment, Foscan-PDT was a cost-effective treatment option at pound 14206/LYS. Sensitivity analysis showed that Foscan-PDT remained cost-effective when the costs used for the comparators were decreased and/or the costs used for Foscan-PDT were increased. Foscan-PDT is a clinically and cost-effective treatment option for patients with advanced head and neck cancer compared to palliative chemotherapy, extensive palliative surgery or 'no treatment'. Furthermore, Foscan-PDT offers patients, with traditionally very limited treatment options, a unique chance of tumour response, remission and increased life expectancy.
