title: A cost-effectiveness analysis of using TheraBite in a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy.
abstract: Previous studies have shown that a "Preventive Exercise Program" (PREP) is cost-effective compared to the standard exercise program provided in "Usual Care" (UC) in patients with advanced head and neck cancer. The current paper specifically estimates the cost-effectiveness of the TheraBite jaw rehabilitation device (TB) which is used as part of the PREP, compared to Speech Language Pathology (SLP) sessions as part of UC, and herewith intents to inform reimbursement discussions regarding the TheraBite device. Costs and outcomes [quality-adjusted life-years (QALYs)] of the TB compared to SLP were estimated using a Markov model of advanced head and neck cancer patients. Secondary outcome variables were trismus, feeding substitutes, facial pain, and pneumonia. The incremental cost-effectiveness ratio (ICER) was estimated from a health care perspective of the Netherlands, with a time horizon of 2 years. The total health care costs per patient were estimated to amount to €5,129 for the TB strategy and €6,915 for the SLP strategy. Based on the current data, the TB strategy yielded more quality-adjusted life-years (1.28) compared to the SLP strategy (1.24). Thus, the TB strategy seems more effective (+0.04) and less costly (-€1,786) than the SLP only strategy. At the prevailing threshold of €20,000/QALY the probability for the TB strategy being cost-effective compared to SLP was 70 %. To conclude, analysis of presently available data indicates that TB is expected to be cost-effective compared to SLP in a preventive exercise program for concomitant chemo-radiotherapy for advanced head and neck cancer patients.
authors: Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. v.retel@nki.nl.|Atos Medical AB, P.O. Box 183, SE-24222, Hörby, Sweden. v.retel@nki.nl.
authors: Valesca P
authors: VP
authors: Retèl
authors: Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. l.vd.molen@nki.nl.
authors: Lisette
authors: L
authors: van der Molen
authors: Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, P.O. Box 19024, Seattle, WA, 98109-1024, USA. lsteuten@fredhutch.org.
authors: Lotte M G
authors: LM
authors: Steuten
authors: Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. m.vd.brekel@nki.nl.|Institute of Phonetic Sciences/ACLC, University of Amsterdam, Spuitstraat 210, 1012 VT, Amsterdam, The Netherlands. m.vd.brekel@nki.nl.|Academic Medical Center, Department of Maxillofacial Surgery, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.vd.brekel@nki.nl.
authors: Michiel W
authors: MW
authors: van den Brekel
authors: Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. f.hilgers@nki.nl.|Institute of Phonetic Sciences/ACLC, University of Amsterdam, Spuitstraat 210, 1012 VT, Amsterdam, The Netherlands. f.hilgers@nki.nl.
authors: Frans J M
authors: FJ
authors: Hilgers
mesh_terms: D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control*; D005081:Exercise Therapy / Q000191:economics / Q000295:instrumentation / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009367:Neoplasm Staging; D009426:Netherlands; D019057:Quality-Adjusted Life Years
keywords: Concomitant chemo-radiotherapy; Cost-effectiveness; Head and neck cancer; Prophylactic dysphagia exercise programs; Rehabilitation; TheraBite