The use of intensive radiological assessments in routine surveillance after treatment for head and neck cancer: An economic evaluation

• Published in: European journal of cancer (1990) 2018-04, Vol.93, p.89-98
• Main Authors: Meregaglia, Michela, Cairns, John, Licitra, Lisa, Bossi, Paolo
• Format: Article
• Language: English
• Subjects: Assessments; Cancer; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - economics; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Clinical trials; Combined Modality Therapy; Computed tomography; Cost analysis; Cost-Benefit Analysis; Cost-utility analysis; Decision analysis; Diagnostic Imaging - methods; Emission analysis; Female; Follow-up; Follow-Up Studies; Head & neck cancer; Head and neck cancer; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - economics; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Health care; Humans; Magnetic resonance imaging; Male; Markov chains; Markov model; Materials selection; Middle Aged; Patients; Population Surveillance; Positron emission tomography; Prognosis; Radiological assessments; Radiology; Sensitivity analysis; Surveillance; Technology Assessment, Biomedical - economics
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2018.01.082

There is uncertainty around the optimal surveillance of head and neck cancer patients after the primary curative treatment. This study aims at assessing the cost-effectiveness of a post-treatment programme of frequent radiological assessments (maximal approach) compared with a symptom-driven surveillance (minimal approach). A decision-analytic Markov model is developed to assess the cost utility of two alternative follow-up programmes with a lifetime horizon. The two interventions differ in the number of radiological assessments (i.e. magnetic resonance imaging, computed tomography and positron-emission tomography) performed over a 5-year period. Clinical and utility parameters are derived from published and unpublished literature and expert opinion. The cost analysis is conducted from the perspective of a major Italian region's health care system. Cost-effectiveness results are expressed as incremental cost per life year gained (LYG) and per quality-adjusted life year (QALY) and checked against a cost-effectiveness threshold of €25,000–40,000 per QALY. One-way, two-way and probabilistic sensitivity analyses are carried out. In the base-case analysis, an intensive programme of radiological investigations leads to 0.10 additional QALYs (0.15 LYG) and an increase in costs of €1903 per patient compared with those of a minimal option, resulting in an incremental cost of €19,951/QALY gained (€13,123/LYG). In probabilistic sensitivity analysis, 72% of the results lie below the €40,000 threshold (55% below €25,000). An intensive post-treatment follow-up with scheduled radiological assessments over time might be cost-effective compared with symptom-driven surveillance in head and neck cancer patients. Further research is needed to check these results in empirical studies or real-world settings. •The optimal number of examinations in head and neck cancer follow-up is uncertain.•A randomised controlled trial is currently ongoing in Italy.•Frequent radiological investigation is compared with symptom-driven surveillance.•A Markov model is developed to estimate the cost utility of the two programmes.•The more intensive follow-up appears cost-effective at around €20,000 per quality-adjusted life year.