title: Cost-Effectiveness of Reduced Waiting Time for Head and Neck Cancer Patients due to a Lean Process Redesign.
abstract: BACKGROUND
  Compared with new technologies, the redesign of care processes is generally considered less attractive to improve patient outcomes. Nevertheless, it might result in better patient outcomes, without further increasing costs. Because early initiation of treatment is of vital importance for patients with head and neck cancer (HNC), these care processes were redesigned.
  
  
  OBJECTIVE
  This study aimed to assess patient outcomes and cost-effectiveness of this redesign.
  
  
  METHODS
  An economic (Markov) model was constructed to evaluate the biopsy process of suspicious lesion under local instead of general anesthesia, and combining computed tomography and positron emission tomography for diagnostics and radiotherapy planning. Patients treated for HNC were included in the model stratified by disease location (larynx, oropharynx, hypopharynx, and oral cavity) and stage (I-II and III-IV). Probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Waiting time before treatment start reduced from 5 to 22 days for the included patient groups, resulting in 0.13 to 0.66 additional quality-adjusted life-years. The new workflow was cost-effective for all the included patient groups, using a ceiling ratio of €80,000 or €20,000. For patients treated for tumors located at the larynx and oral cavity, the new workflow resulted in additional quality-adjusted life-years, and costs decreased compared with the regular workflow. The health care payer benefited €14.1 million and €91.5 million, respectively, when individual net monetary benefits were extrapolated to an organizational level and a national level.
  
  
  CONCLUSIONS
  The redesigned care process reduced the waiting time for the treatment of patients with HNC and proved cost-effective. Because care improved, implementation on a wider scale should be considered.
authors: Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: pascale.simons@maastro.nl.
authors: Pascale A M
authors: PA
authors: Simons
authors: Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Bram
authors: B
authors: Ramaekers
authors: Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Frank
authors: F
authors: Hoebers
authors: Department of Otolaryngology/Head & Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: Kenneth W
authors: KW
authors: Kross
authors: Faculty of Business Economics, Hasselt University, Hasselt, Belgium.
authors: Wim
authors: W
authors: Marneffe
authors: CZ Insurances, Tilburg, The Netherlands.
authors: Madelon
authors: M
authors: Pijls-Johannesma
authors: Faculty of Business Economics, Hasselt University, Hasselt, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors: Dominique
authors: D
authors: Vandijck
mesh_terms: D000768:Anesthesia, General / Q000191:economics; D000772:Anesthesia, Local / Q000191:economics; D001706:Biopsy / Q000191:economics; D003362:Cost-Benefit Analysis; D019937:Diagnostic Techniques and Procedures / Q000191:economics*; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D064847:Multimodal Imaging / Q000191:economics; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000191:economics; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care / Q000191:economics*; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D061665:Time-to-Treatment / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics; D016896:Treatment Outcome; D014850:Waiting Lists; D057188:Workflow
keywords: cost-effectiveness analysis; economic evaluation; head and neck; process redesign; waiting time