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

• Published in: Oral oncology 2021-06, Vol.117, p.105306-105306, Article 105306
• Main 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.
• Format: Article
• Language: English
• Subjects: Cost-Benefit Analysis; Cost-effectiveness; Cost-utility; Deglutition Disorders - etiology; Economic evaluation; Exercise program; Exercise Therapy; Head and neck cancer; Humans; Laryngectomy - adverse effects; Laryngectomy - economics; Laryngectomy - methods; Quality of Life; Quality-Adjusted Life Years; Shoulder problems; Speech problems; Swallowing problems; Total laryngectomy
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2021.105306

•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. 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. 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. 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). ITwC is likely to be effective, but possibly at higher expenses. Trial Registration: NTR5255.