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Cost-effectiveness analysis of (accelerated) pre-operative versus (conventional) post-operative radiotherapy for patients with oral cavity cancer in Sweden

Silfverschiöld, Maria LU orcid ; Carlwig, Kristin LU ; Jarl, Johan LU orcid ; Greiff, Lennart LU ; Nilsson, Per LU orcid ; Wennerberg, Johan LU orcid ; Zackrisson, Björn ; Östensson, Ellinor and Sjövall, Johanna LU (2023) In European Journal of Health Economics
Abstract

BACKGROUND: Treatment for resectable oral cavity cancer (OCC) often includes combinations of surgery and radiotherapy (RT), but there is no conclusive information on the preferred treatment order. The aim of this study was to assess the costs and cost-effectiveness of two alternative treatment regimens for patients with OCC, reflecting pre- and post-operative RT, from a societal perspective.

METHODS: The study used data from the ARTSCAN 2 randomised controlled trial, which compares pre-operative accelerated RT with post-operative conventionally fractionated RT. Two-hundred-forty patients were included in the analysis of treatment outcomes. Direct costs were retrieved from the hospital's economic systems, while indirect costs were... (More)

BACKGROUND: Treatment for resectable oral cavity cancer (OCC) often includes combinations of surgery and radiotherapy (RT), but there is no conclusive information on the preferred treatment order. The aim of this study was to assess the costs and cost-effectiveness of two alternative treatment regimens for patients with OCC, reflecting pre- and post-operative RT, from a societal perspective.

METHODS: The study used data from the ARTSCAN 2 randomised controlled trial, which compares pre-operative accelerated RT with post-operative conventionally fractionated RT. Two-hundred-forty patients were included in the analysis of treatment outcomes. Direct costs were retrieved from the hospital's economic systems, while indirect costs were obtained from national registries. Cost-effectiveness was assessed and a sensitivity analysis was performed. Overall survival (OS) at 5 years, was used as effect measure in the analysis.

RESULTS: Two-hundred-nine patients completed the treatments and had retrievable data on costs. Mean direct costs (inpatient and outpatient care) were € 47,377 for pre-operative RT and € 39,841 for post-operative RT (p = 0.001), while corresponding indirect costs were € 19,854 and € 20,531 (p = 0.89). The incremental cost, i.e., the mean difference in total cost between the treatment regimens, was € 6859 paralleled with a 14-percentage point lower OS-rate at 5 years for pre-operative RT (i.e., 58 vs. 72%). Thus, pre-operative RT was dominated by post-operative RT.

CONCLUSIONS: From a societal perspective, post-operative RT for patients with resectable OCC is the dominant strategy compared to pre-operative RT.

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Contribution to journal
publication status
epub
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in
European Journal of Health Economics
publisher
Springer
external identifiers
  • scopus:85149223461
  • pmid:36870031
ISSN
1618-7601
DOI
10.1007/s10198-023-01578-7
language
English
LU publication?
yes
id
0e7425f3-0ee6-46dc-9c5e-a9471c2d3df7
date added to LUP
2023-03-08 11:30:52
date last changed
2024-04-18 04:59:16
@article{0e7425f3-0ee6-46dc-9c5e-a9471c2d3df7,
  abstract     = {{<p>BACKGROUND: Treatment for resectable oral cavity cancer (OCC) often includes combinations of surgery and radiotherapy (RT), but there is no conclusive information on the preferred treatment order. The aim of this study was to assess the costs and cost-effectiveness of two alternative treatment regimens for patients with OCC, reflecting pre- and post-operative RT, from a societal perspective.</p><p>METHODS: The study used data from the ARTSCAN 2 randomised controlled trial, which compares pre-operative accelerated RT with post-operative conventionally fractionated RT. Two-hundred-forty patients were included in the analysis of treatment outcomes. Direct costs were retrieved from the hospital's economic systems, while indirect costs were obtained from national registries. Cost-effectiveness was assessed and a sensitivity analysis was performed. Overall survival (OS) at 5 years, was used as effect measure in the analysis.</p><p>RESULTS: Two-hundred-nine patients completed the treatments and had retrievable data on costs. Mean direct costs (inpatient and outpatient care) were € 47,377 for pre-operative RT and € 39,841 for post-operative RT (p = 0.001), while corresponding indirect costs were € 19,854 and € 20,531 (p = 0.89). The incremental cost, i.e., the mean difference in total cost between the treatment regimens, was € 6859 paralleled with a 14-percentage point lower OS-rate at 5 years for pre-operative RT (i.e., 58 vs. 72%). Thus, pre-operative RT was dominated by post-operative RT.</p><p>CONCLUSIONS: From a societal perspective, post-operative RT for patients with resectable OCC is the dominant strategy compared to pre-operative RT.</p>}},
  author       = {{Silfverschiöld, Maria and Carlwig, Kristin and Jarl, Johan and Greiff, Lennart and Nilsson, Per and Wennerberg, Johan and Zackrisson, Björn and Östensson, Ellinor and Sjövall, Johanna}},
  issn         = {{1618-7601}},
  language     = {{eng}},
  month        = {{03}},
  publisher    = {{Springer}},
  series       = {{European Journal of Health Economics}},
  title        = {{Cost-effectiveness analysis of (accelerated) pre-operative versus (conventional) post-operative radiotherapy for patients with oral cavity cancer in Sweden}},
  url          = {{http://dx.doi.org/10.1007/s10198-023-01578-7}},
  doi          = {{10.1007/s10198-023-01578-7}},
  year         = {{2023}},
}