title: Cost-effectiveness of low-level laser therapy (LLLT) in head and neck cancer patients receiving concurrent chemoradiation.
abstract: BACKGROUND
  Oral mucositis is a major event increasing treatment costs of head and neck squamous cell carcinoma (HNSCC) patients treated with chemoradiation (CRT). This study was designed to estimate the cost-effectiveness of low-level laser therapy (LLLT) to prevent oral mucositis in HNSCC patients receiving CRT.
  
  
  METHODS
  From June 2007 to December 2010, 94 patients with HNSCC of nasopharynx, oropharynx, and hypopharynx entered a prospective, randomized, double blind, placebo-controlled, phase III trial. CRT consisted of conventional radiotherapy (RT: 70.2 Gy, 1.8 Gy/d, 5 times/wk)+concurrent cisplatin (100mg/m2) every 3 weeks. An InGaAlP (660 nm-100 mW-4J/cm2) laser diode was used for LLLT.
  
  
  RESULTS
  From the perspective of Brazil's public health care system (SUS), total costs were higher in Placebo Group (PG) than Laser Group (LG) for opioid use (LG=US$ 9.08, PG=US$ 44.28), gastrostomy feeding (LG=US$ 50.50, PG=US$ 129.86), and hospitalization (PG=US$ 77.03). In LG, the cost was higher for laser therapy only (US$ 1880.57). The total incremental cost associated with the use of LLLT was US$ 1689.00 per patient. The incremental cost-effectiveness ratio (ICER) was US$ 4961.37 per grade 3-4 OM case prevented compared to no treatment.
  
  
  CONCLUSIONS
  Our results indicate that morbidity was lower in the Laser Group and that LLLT was more cost-effective than placebo up to a threshold of at least US$ 5000 per mucositis case prevented.
  
  
  BACKGROUND
  NCT01439724.
authors.affiliation: Clinical Research Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil. Electronic address: hspindola@inca.gov.br.
authors.forename: Héliton S
authors.initials: HS
authors.lastname: Antunes
authors.affiliation: Clinical Research Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
authors.forename: Luciene Fontes
authors.initials: LF
authors.lastname: Schluckebier
authors.affiliation: Clinical Oncology Division, INCA, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herchenhorn
authors.affiliation: Clinical Research Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
authors.forename: Isabele A
authors.initials: IA
authors.lastname: Small
authors.affiliation: Radiation Oncology Division, INCA, Brazil.
authors.forename: Carlos M M
authors.initials: CM
authors.lastname: Araújo
authors.affiliation: Radiation Oncology Division, INCA, Brazil.
authors.forename: Celia Maria Pais
authors.initials: CM
authors.lastname: Viégas
authors.affiliation: Clinical Research Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
authors.forename: Mariana P
authors.initials: MP
authors.lastname: Rampini
authors.affiliation: Private Practice, Brazil.
authors.forename: Elza M S
authors.initials: EM
authors.lastname: Ferreira
authors.affiliation: Head and Neck Surgery Division, INCA, Brazil.
authors.forename: Fernando L
authors.initials: FL
authors.lastname: Dias
authors.affiliation: Instituto COI de Educação e Pesquisa, Brazil.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Teich
authors.affiliation: Instituto COI de Educação e Pesquisa, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Teich
authors.affiliation: Clinical Research Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Brazilian Network for Clinical Cancer Research (RNPCC), Brazil; D'OR Institute for Research and Education (IDOR), Brazil.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Ferreira
mesh_terms: D000368:Aged; D001938:Brazil; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000628:therapy*; D006801:Humans; D028022:Low-Level Light Therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000191:economics / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Chemotherapy; Cost-effectiveness; Head and neck cancer; Low-level laser therapy; Oral mucositis; Quality of life; Radiotherapy