Cost-effectiveness analysis of scalp cooling to reduce chemotherapy-induced alopecia.
BACKGROUND
Alopecia is a frequently occurring side effect of chemotherapy that often can be prevented by cooling the scalp during the infusion. This study compared effects and costs of scalp cooling with usual general oncological care, i.e. purchasing a wig or head cover.


METHODS
Scalp-cooled patients (n = 160) were compared with non-scalp-cooled patients (n = 86) at 15 Dutch hospitals. Patients were enrolled prior to anthracycline and/or taxane-based chemotherapy for several types of cancer between 2007 and 2008. Cost-effectiveness of scalp cooling compared with that of usual care was determined by the ratio of costs to quality adjusted life years (QALYs). Costs for scalp cooling (machines and nursing time), hair dressers, wigs and head covers were estimated from a societal perspective. QALYs were measured using the Short Form-36.


RESULTS
Scalp cooling reduced the use of a wig or head cover by 40%, but wigs were still purchased unnecessarily by 38% of scalp-cooled patients. Average societal costs decreased therefore only by €269 per patient due to scalp cooling (p = 0.02). Given the eligibility for scalp cooling at the time, the insignificant difference in QALYs resulted from a balance of the benefits for those patients with successful scalp cooling and those without success. For the Dutch, given the generally accepted threshold of willingness to pay for a QALY (between €20 000 and €40 000), scalp cooling was cost-effective, therefore justifying the choice of scalp cooling or purchasing a wig or head cover.


CONCLUSIONS
Given the right indication, cost-effectiveness might be improved further by postponing wig and head cover purchases, by improving scalp cooling efficacy, as well as using the scalp cooling capacity more intensively.
Research Department, Eindhoven Cancer Registry/Comprehensive Cancer Centre South , Eindhoven , The Netherlands.
Corina J
CJ
van den Hurk
M Elske
ME
van den Akker-van Marle
Wim P
WP
Breed
Lonneke V
LV
van de Poll-Franse
Johan W
JW
Nortier
Jan W
JW
Coebergh
D000328:Adult; D000368:Aged; D000505:Alopecia / Q000139:chemically induced / Q000191:economics* / Q000517:prevention & control*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012535:Scalp