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

Author

Listed:
  • Maria Silfverschiöld

    (Skåne University Hospital
    Lund University)

  • Kristin Carlwig

    (Skåne University Hospital
    Lund University)

  • Johan Jarl

    (Lund University)

  • Lennart Greiff

    (Skåne University Hospital
    Lund University)

  • Per Nilsson

    (Lund University
    Skåne University Hospital)

  • Johan Wennerberg

    (Skåne University Hospital
    Lund University)

  • Björn Zackrisson

    (Umeå University Hospital)

  • Ellinor Östensson

    (Karolinska Institutet
    Karolinska Institutet)

  • Johanna Sjövall

    (Skåne University Hospital
    Lund University)

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 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.

Suggested Citation

  • Maria Silfverschiöld & Kristin Carlwig & Johan Jarl & Lennart Greiff & Per Nilsson & Johan Wennerberg & Björn Zackrisson & Ellinor Östensson & Johanna Sjövall, 2024. "Cost-effectiveness analysis of (accelerated) pre-operative versus (conventional) post-operative radiotherapy for patients with oral cavity cancer in Sweden," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(1), pages 177-185, February.
    • Handle: RePEc:spr:eujhec:v:25:y:2024:i:1:d:10.1007_s10198-023-01578-7
    DOI: 10.1007/s10198-023-01578-7
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    References listed on IDEAS

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    1. Aziz Rezapour & Reza Jahangiri & Alireza Olyaeemanesh & Bita Kalaghchi & Mojtaba Nouhi & Azin Nahvijou, 2018. "The economic burden of oral cancer in Iran," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-12, September.
    2. Akashdeep Singh Chauhan & Shankar Prinja & Sushmita Ghoshal & Roshan Verma & Arun S Oinam, 2018. "Cost of treatment for head and neck cancer in India," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-13, January.
    3. Alison Pearce & Paul Hanly & Aileen Timmons & Paul Walsh & Ciaran O’Neill & Eleanor O’Sullivan & Rachael Gooberman-Hill & Audrey Thomas & Pamela Gallagher & Linda Sharp, 2015. "Productivity Losses Associated with Head and Neck Cancer Using the Human Capital and Friction Cost Approaches," Applied Health Economics and Health Policy, Springer, vol. 13(4), pages 359-367, August.
    4. Maria Silfverschiöld & Johanna Sjövall & Johan Wennerberg & Ellinor Östensson & Lennart Greiff, 2019. "Societal cost of oropharyngeal cancer by human papillomavirus status, cancer stage, and subsite," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-9, July.
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