Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden.
Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
Support Care Cancer. 2020 Nov;28(11):5203-5211. doi: 10.1007/s00520-020-05362-8. Epub 2020 Feb 20.
Voice problems are common following radiotherapy for laryngeal cancer. Few studies exist covering the effect of voice rehabilitation, and no previous studies exist regarding the cost of said rehabilitation. This randomized controlled study aimed to analyze the cost-effectiveness of voice rehabilitation after radiotherapy for patients with laryngeal cancer.
A total of 66 patients with laryngeal cancer with follow-up data 12 months post-radiotherapy were included. Patients were randomized into receiving either voice rehabilitation (n = 32) or no voice rehabilitation (n = 34). The patient outcome was measured as quality-adjusted life years (QALYs). The index range between 0 and 1, where 0 equals death and 1 represents perfect health. The QALYs were assessed with the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30 mapped to EuroQoL 5 Dimension values. The cost of rehabilitation and other healthcare visits was derived from hospital systems. The patients reported the total amount of sick leave days during the first 12 months following radiotherapy. The cost-effectiveness of the voice rehabilitation was compared with no rehabilitation intervention based on the incremental cost-effectiveness ratio.
The cost per gained QALY with voice rehabilitation compared to no rehabilitation from a societal perspective was - 27,594 € (SEK - 250,852) which indicates that the voice rehabilitation is a cost-saving alternative compared to no rehabilitation due to lower costs and a slightly better health outcome. From a healthcare perspective, the voice rehabilitation indicates a cost 60,800 € (SEK 552,725) per gained QALY.
From a societal perspective, i.e., including the costs of production loss, voice rehabilitation compared to no voice rehabilitation following radiotherapy for laryngeal cancer seems to be cost-saving. When analyzing only the healthcare costs in relation to health outcomes, voice rehabilitation indicates an incremental cost of 60,800 € per gained QALY, which is just above the threshold of the maximum willingness to pay level.
喉癌放疗后常出现嗓音问题。虽有少数研究涉及嗓音康复效果，但尚无研究涉及该康复的成本。本随机对照研究旨在分析喉癌放疗后患者进行嗓音康复的成本效益。
共纳入 66 例喉癌患者，放疗后随访 12 个月。患者随机分为接受嗓音康复治疗组（n=32）和未接受嗓音康复治疗组（n=34）。以质量调整生命年（QALY）作为患者结局的衡量指标。指数范围在 0 到 1 之间，0 表示死亡，1 表示完全健康。QALY 通过欧洲癌症研究与治疗组织生活质量问卷 EORTC QLQ-C30 映射到欧洲五维健康量表（EQ-5D）的值来评估。康复和其他医疗就诊的费用源自医院系统。患者报告放疗后 12 个月内的总病假天数。根据增量成本效益比，比较嗓音康复治疗与无康复干预的成本效益。
从社会角度来看，与无康复干预相比，嗓音康复治疗每获得一个 QALY 的成本为-27594 欧元（瑞典克朗-250852），这表明由于成本较低且健康结果略好，嗓音康复治疗是一种节省成本的替代方案。从医疗保健角度来看，嗓音康复治疗每获得一个 QALY 的成本为 60800 欧元。
从社会角度来看，即包括生产损失成本，与喉癌放疗后不进行嗓音康复相比，嗓音康复似乎具有成本效益。仅分析与健康结果相关的医疗保健成本时，嗓音康复每获得一个 QALY 的增量成本为 60800 欧元，略高于最高意愿支付水平的阈值。
