Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial. (June 2021)

• Record Type: Journal Article
• Authors: Jansen, Femke; Coupé, Veerle M.H.; Eerenstein, Simone E.J.; Cnossen, Ingrid C.; van Uden-Kraan, Cornelia F.; de Bree, Remco; Doornaert, Patricia; Halmos, György B.; Hardillo, José A.U.; van Hinte, Gerben; Honings, Jimmie; Leemans, C. René; Verdonck-de Leeuw, Irma M.
• Is Part Of: Oral oncology. Volume 117(2021)
• Publication Date: 2021-06
• Subjects: Exercise program -- Total laryngectomy -- Head and neck cancer -- Swallowing problems -- Speech problems -- Shoulder problems -- Economic evaluation -- Cost-utility -- Cost-effectiveness; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2021.105306
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: In Tune without Cords is likely to be effective, but possibly at higher expenses. The probability to be cost-effective is 57–64% at a threshold of 20, 000 €/QALY. The probability to be cost-effective is 65–70% at a threshold of 30, 000 €/QALY. Abstract: Objectives: The guided self-help exercise program called In Tune without Cords (ITwC) is effective in improving swallowing problems and communication among patients treated with a total laryngectomy (TL). This study investigated the cost-utility and cost-effectiveness of ITwC. Materials and methods: Patients within 5 years after TL were included in this randomized controlled trial. Patients in the intervention group (n = 46) received access to the self-help exercise program with flexibility, range-of-motion and lymphedema exercises, and a self-care education program. Patients in the control group (n = 46) received access to the self-care education program only. Healthcare utilization (iMCQ), productivity losses (iPCQ), health status (EQ-5D-3L, EORTC QLU-C10D) and swallowing problems (SwalQol) were measured at baseline, 3- and 6-months follow-up. Hospital costs were extracted from medical files. Mean total costs and effects (quality-adjusted life-years (QALYs) or SwalQol score) were compared with regression analyses using bias-corrected accelerated bootstrapping. Results: Mean total costs were non-significantly lower (-€685) and QALYs were significantly higher (+0.06) in the intervention compared to the control group. The probability that the intervention is less costly and more effective was 73%. Sensitivity analyses with adjustment for baseline costs and EQ-5D scores showed non-significantly higher costs (+€119 to +€364) and QALYs (+0.02 to +0.03). A sensitivity analysis using the QLU-C10D to calculate QALYs showed higher costs (+€741) and lower QALYs (-0.01) and an analysis that used the SwalQol showed higher costs (+€232) and higher effects (improvement of 6 points on a 0–100 scale). Conclusion: ITwC is likely to be effective, but possibly at higher expenses. Trial Registration: NTR5255.