Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Department of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
BMC Cancer. 2011 Nov 3;11:475. doi: 10.1186/1471-2407-11-475.
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.
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.
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.
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).
同期放化疗（CCRT）已成为治疗晚期头颈部癌症不可或缺的手段，但并非总是能保留器官功能的治疗方式。为了预防/限制 CCRT 的功能副作用，越来越多的研究探索了特殊的运动方案。本研究从医疗保健的角度，比较了预防性（吞咽）运动方案（PREP）与常规护理（UC）的成本效益分析。
为 CCRT 治疗晚期头颈部癌症开发了 PREP 与 UC 的 Markov 决策模型。主要结果变量为一年时的管饲依赖和 CCRT 后住院天数。主要结果是每质量调整生命年的成本（成本/QALY），增量成本效益比（ICER）为结果参数。计算期望完美信息价值（EVPI）以获得进一步研究的价值。
与 UC 相比，PREP 导致管饲依赖的比例较低（分别为 3%和 25%），住院天数也较少（分别为 3.2 天和 4.5 天）。UC 的总费用为 41986 欧元，PREP 的费用为 42271 欧元。UC 的质量调整生命年为 0.68，PREP 为 0.77。基于成本/QALY，只要支付意愿阈值至少为 3200 欧元/QALY，PREP 就更有可能具有成本效益。在 20000 欧元/QALY 的现行阈值下，与 UC 相比，PREP 具有成本效益的可能性为 83%。EVPI 表明，在降低现有决策不确定性方面，开展额外研究具有潜在价值。
基于当前证据，与 UC 相比，CCRT 治疗晚期头颈部癌症时，PREP 更有可能具有成本效益。此外，大多数敏感性分析产生的 ICER 远低于现行的额外 QALY 支付意愿阈值（从主导到 45906 欧元/QALY）。
