Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.
Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Laryngoscope. 2021 Feb;131(2):E509-E517. doi: 10.1002/lary.28954. Epub 2020 Aug 10.
Treatment decision-making for patients with laryngeal cancer consists of a complex trade-off between survival and quality of life. For decision makers on coverage and guidelines, costs come in addition to this equation. Our aim was to perform a cost-effectiveness analysis of surgery (laryngectomy with or without radiotherapy) versus organ preservation (OP: radiotherapy, chemo- and/or bioradiation) in advanced laryngeal cancer patients from a healthcare perspective.
A cost-effectiveness analysis was conducted using a Markov model. For each modality, data on survival and quality-adjusted life years (QALYs) were sourced from relevant articles in agreement with experts, and national benchmark cost prices were included regarding treatment, follow-up, adverse events, and rehabilitation.
Total QALYs of the surgical approach (6.59) were substantially higher compared to the OP approach (5.44). Total lifetime costs were higher for the surgical approach compared to the OP approach, namely €95,881 versus €47,233. The surgical approach was therefore more effective and more costly compared to OP, resulting in an incremental cost-effectiveness ratio of €42,383/QALY.
Based on current literature, surgical treatment was cost-effective compared to OP in advanced laryngeal cancer within most willingness-to-pay thresholds. The study provides information on the survival adjusted for quality of life in combination with costs of two different approaches for advanced laryngeal cancer, relevant for patients, physicians, and policy makers. As financial toxicity is a relevant aspect in this population, collection of real-world data on country-specific costs and utilities is strongly recommended to enable further generalization.
N/A. Laryngoscope, 131:E509-E517, 2021.
喉癌患者的治疗决策涉及生存和生活质量之间的复杂权衡。对于覆盖范围和指南的决策者而言，成本是除了这个因素之外的另一个考量。我们的目的是从医疗保健的角度，对晚期喉癌患者的手术（喉切除术加或不加放疗）与器官保留（OP：放疗、化疗和/或生物放疗）进行成本效益分析。
采用 Markov 模型进行成本效益分析。对于每种治疗方式，生存和质量调整生命年（QALY）的数据均来自于相关文章，并与专家意见一致，同时还包括了关于治疗、随访、不良反应和康复的国家基准成本价格。
与 OP 治疗方式相比，手术治疗方式的总 QALY（6.59）显著更高。与 OP 治疗方式相比，手术治疗方式的总终生成本更高，分别为€95881 与€47233。因此，与 OP 相比，手术治疗方式更有效但成本更高，增量成本效益比为€42383/QALY。
基于当前文献，在大多数支付意愿阈值内，与 OP 相比，手术治疗在晚期喉癌中具有成本效益。本研究提供了在生存质量调整的基础上，结合两种不同晚期喉癌治疗方法的成本的信息，这对患者、医生和决策者都具有重要意义。由于该人群存在财务毒性问题，强烈建议收集关于国家特定成本和效用的真实世界数据，以进一步推广。
N/A。《喉镜》，131：E509-E517，2021 年。
