Martin Beatrice, Cereda Emanuele, Caccialanza Riccardo, Pedrazzoli Paolo, Tarricone Rosanna, Ciani Oriana
Department of Social and Political Science, Bocconi University, Milan, Italy.
Clinical Nutrition and Dietetics Unit, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy.
Cost Eff Resour Alloc. 2021 Jun 15;19(1):35. doi: 10.1186/s12962-021-00291-7.
There is limited evidence regarding the economic effects of nutrition support in cancer patients. This study aims at investigating the cost-effectiveness profile of systematic oral nutritional supplementation (ONS) in head and neck cancer (HNC) patients undergoing radiotherapy (RT) and receiving nutritional counseling.
A cost-effectiveness analysis based on a RCT was performed to estimate direct medical costs, life years gained (LYG) and Quality-Adjusted Life Years (QALY) for nutritional counseling with or without ONS at 5-month and 6-year follow up time. Value of information analysis was performed to value the expected gain from reducing uncertainty through further data collection.
ONS with nutritional counseling produced higher QALY than nutritional counseling alone (0.291 ± 0.087 vs 0.288 ± 0.087), however the difference was not significant (0.0027, P = 0.84). Mean costs were €987.60 vs €996.09, respectively in the treatment and control group (-€8.96, P = 0.98). The Incremental Cost Effectiveness Ratio (ICER) was -€3,277/QALY, with 55.4% probabilities of being cost-effective at a cost-effectiveness threshold of €30,000/QALY. The Expected Incremental Benefit was €95.16 and the Population Expected Value of Perfect Information was €8.6 million, implying that additional research is likely to be worthwhile. At a median 6-year follow up, the treatment group had a significantly better survival rate when adjusting for late effect (P = 0.039).
Our findings provide the first evidence to inform decisions about funding and reimbursement of ONS in combination with nutritional counseling in HNC patients undergoing RT. ONS may improve quality of cancer care at no additional costs, however further research on the cost-effectiveness of nutritional supplementation is recommended.
ClinicalTrials.gov: NCT02055833. Registered 5th February 2014 https://clinicaltrials.gov/ct2/show/NCT02055833.
关于营养支持对癌症患者经济影响的证据有限。本研究旨在调查对头颈部癌（HNC）患者进行放射治疗（RT）并接受营养咨询时，系统性口服营养补充（ONS）的成本效益情况。
基于一项随机对照试验（RCT）进行成本效益分析，以估计在5个月和6年随访期内，有或无ONS的营养咨询的直接医疗成本、获得的生命年（LYG）和质量调整生命年（QALY）。进行信息价值分析，以评估通过进一步数据收集减少不确定性所带来的预期收益。
ONS联合营养咨询产生的QALY高于单纯营养咨询（0.291±0.087对0.288±0.087），但差异不显著（0.0027，P = 0.84）。治疗组和对照组的平均成本分别为987.60欧元和996.09欧元（-8.96欧元，P = 0.98）。增量成本效益比（ICER）为-3277欧元/QALY，在30000欧元/QALY的成本效益阈值下，具有成本效益的概率为55.4%。预期增量效益为95.16欧元，总体完美信息预期价值为860万欧元，这意味着进一步的研究可能是值得的。在中位6年随访时，调整后期影响后，治疗组的生存率显著更高（P = 0.039）。
我们的研究结果为决定是否资助和报销接受RT的HNC患者的ONS联合营养咨询提供了首个证据。ONS可能在不增加成本的情况下提高癌症护理质量，然而建议对营养补充的成本效益进行进一步研究。
ClinicalTrials.gov：NCT02055833。2014年2月5日注册https://clinicaltrials.gov/ct2/show/NCT02055833
