title: Cost effectiveness of neoadjuvant chemotherapy in locally advanced operable head and neck cancer followed by surgery and postoperative radiotherapy: a Markov model-based decision analysis.
abstract: BACKGROUND
  Head and neck carcinomas are among the most frequent tumor diseases and, because of different multimodal therapy options, cause enormous costs. For this reason, we examined whether in operable advanced head and neck carcinomas, neoadjuvant induction chemotherapy is cost effective in comparison with surgery followed by postoperative radio(chemo)therapy.
  
  
  METHODS
  A Markov model was developed with paclitaxel, cisplatin and fluorouracil as induction therapy. The legal health insurance in Germany was chosen for cost perspectives, and a willingness-to-pay limit at EUR 38,000 was set.
  
  
  RESULTS
  Total costs for surgery with postoperative radiochemotherapy amounted to EUR 13,999. Prior induction chemotherapy raised the costs to EUR 17,377, with a higher effectiveness by 0.1 years of life. Costs per year of life gained are EUR 33,780. The incremental cost effectiveness ratio (ICER) with variations in side effects for surgery and postoperative chemotherapy amounted to between EUR 31,520 and 36,050. With variations in side effects for induction chemotherapy, the ICER amounted to EUR 30,060-37,520. The Monte Carlo simulation disclosed cost effectiveness for 55.4% of the patients; for 44.6%, there was no cost effectiveness.
  
  
  CONCLUSIONS
  The Markov-modeled cost effectiveness analysis indicates that with operable head and neck tumors, induction therapy with paclitaxel, cisplatin and fluorouracil is cost effective.
authors: Hospital Pharmacy, University Hospital Jena, Jena, Germany.
authors: M
authors: M
authors: Himmel
authors: M
authors: M
authors: Hartmann
authors: O
authors: O
authors: Guntinas-Lichius
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000191:economics; D002945:Cisplatin / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D018572:Disease-Free Survival; D005472:Fluorouracil / Q000008:administration & dosage / Q000191:economics; D005858:Germany; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000191:economics*; D053208:Kaplan-Meier Estimate; D008390:Markov Chains; D009010:Monte Carlo Method; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000191:economics*; D017239:Paclitaxel / Q000008:administration & dosage / Q000191:economics
chemical_list: D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil