Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.
German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
Strahlenther Onkol. 2022 Nov;198(11):1008-1015. doi: 10.1007/s00066-022-01975-6. Epub 2022 Jul 14.
Radiotherapy (RT) constitutes a mainstay in the treatment of elderly patients with head and neck cancer (HNC), but use of simultaneous chemoradiotherapy (CRT) remains controversial. We have conducted a prospective analysis based on real-world patient data to examine the health-related quality of life (HRQoL) and cost effectiveness (CE) of CRT vs. RT in elderly HNC patients.
Eligible participants ≥ 65 years treated in a large tertiary cancer center between July 2019 and February 2020 who completed the validated EQ-5D-5L questionnaire (health state index [HI] and visual analog scale [VAS]) before and after RT were included. CE referred to direct medical costs, including diagnosis-related group (DRG)-based billings for inpatients and uniform assessment standard (EBM)-based costs for outpatients. The primary endpoint was cost (euros [€]) per quality-adjusted life year (QALY). The incremental cost-effectiveness ratios (ICERs) were calculated. Costs and QALYs were not discounted for short overall survival (OS).
Baseline HRQoL was 0.878 (±0.11) in the CRT group and 0.857 (±0.17) in the RT group. Upon completion of therapy, HRQoL amounted to 0.849 (±0.14) in the CRT and 0.850 (±0.13) in the RT group. The mean treatment-related cost in the CRT cohort was €22,180.17 (±8325.26) vs. €18,027.87 (±26,022.48) in the RT group. The corresponding QALYs amounted to 2.62 in the CRT and 1.91 in the RT groups. The ICER was €5848.31.
This is the first analysis from the German health care system demonstrating that the addition of chemotherapy to RT for selected elderly HNC patients is cost effective and not associated with a significant HRQoL decline.
放射治疗（RT）是治疗老年头颈部癌症（HNC）患者的主要手段，但同步放化疗（CRT）的应用仍存在争议。我们基于真实世界的患者数据进行了前瞻性分析，以检查 CRT 与 RT 治疗老年 HNC 患者的健康相关生活质量（HRQoL）和成本效益（CE）。
纳入 2019 年 7 月至 2020 年 2 月在一家大型三级癌症中心接受治疗的年龄≥65 岁的合格患者，这些患者在 RT 前后完成了经过验证的 EQ-5D-5L 问卷（健康状态指数[HI]和视觉模拟量表[VAS]）。CE 指直接医疗费用，包括基于诊断相关组（DRG）的住院费用和基于统一评估标准（EBM）的门诊费用。主要终点是每质量调整生命年（QALY）的成本（欧元[€]）。计算了增量成本效益比（ICER）。由于总体生存（OS）较短，因此未对成本和 QALY 进行贴现。
CRT 组的基线 HRQoL 为 0.878（±0.11），RT 组为 0.857（±0.17）。治疗结束时，CRT 组的 HRQoL 为 0.849（±0.14），RT 组为 0.850（±0.13）。CRT 队列的平均治疗相关费用为€22,180.17（±8325.26），而 RT 队列为€18,027.87（±26,022.48）。相应的 QALYs 在 CRT 组为 2.62，在 RT 组为 1.91。ICER 为€5848.31。
这是德国卫生保健系统的第一项分析，表明为选定的老年 HNC 患者选择 CRT 加化疗是具有成本效益的，并且不会导致 HRQoL 显著下降。
