Cost-effectiveness analysis of (accelerated) pre-operative versus (conventional) post-operative radiotherapy for patients with oral cavity cancer in Sweden
(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.
(Less)
- author
- Silfverschiöld, Maria LU ; Carlwig, Kristin LU ; Jarl, Johan LU ; Greiff, Lennart LU ; Nilsson, Per LU ; Wennerberg, Johan LU ; Zackrisson, Björn ; Östensson, Ellinor and Sjövall, Johanna LU
- organization
-
- Otorhinolaryngology (Lund)
- Head and Neck Cancer Research Group (research group)
- Health Economics (research group)
- Health care related infections in seriously and critically ill patients (research group)
- Radiotherapy Physics (research group)
- Medical Radiation Physics, Lund
- Department of Clinical Sciences, Lund
- publishing date
- 2023-03-04
- type
- Contribution to journal
- publication status
- epub
- subject
- 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}}, }