The use of intensive radiological assessments in routine surveillance after treatment for head and neck cancer

An economic evaluation

Michela Meregaglia, John Cairns, Lisa Licitra, Paolo Bossi

Research output: Contribution to journalArticle

Abstract

BACKGROUND: There is uncertainty around the optimal surveillance of head and neck cancer patients after the primary curative treatment. This study aims at assessing the cost-effectiveness of a post-treatment programme of frequent radiological assessments (maximal approach) compared with a symptom-driven surveillance (minimal approach).

MATERIALS AND METHODS: A decision-analytic Markov model is developed to assess the cost utility of two alternative follow-up programmes with a lifetime horizon. The two interventions differ in the number of radiological assessments (i.e. magnetic resonance imaging, computed tomography and positron-emission tomography) performed over a 5-year period. Clinical and utility parameters are derived from published and unpublished literature and expert opinion. The cost analysis is conducted from the perspective of a major Italian region's health care system. Cost-effectiveness results are expressed as incremental cost per life year gained (LYG) and per quality-adjusted life year (QALY) and checked against a cost-effectiveness threshold of €25,000-40,000 per QALY. One-way, two-way and probabilistic sensitivity analyses are carried out.

RESULTS: In the base-case analysis, an intensive programme of radiological investigations leads to 0.10 additional QALYs (0.15 LYG) and an increase in costs of €1903 per patient compared with those of a minimal option, resulting in an incremental cost of €19,951/QALY gained (€13,123/LYG). In probabilistic sensitivity analysis, 72% of the results lie below the €40,000 threshold (55% below €25,000).

CONCLUSIONS: An intensive post-treatment follow-up with scheduled radiological assessments over time might be cost-effective compared with symptom-driven surveillance in head and neck cancer patients. Further research is needed to check these results in empirical studies or real-world settings.

Original languageEnglish
Pages (from-to)89-98
Number of pages10
JournalEuropean Journal of Cancer
Volume93
DOIs
Publication statusPublished - Apr 2018

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Head and Neck Neoplasms
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Therapeutics
Expert Testimony
Uncertainty
Magnetic Resonance Imaging
Delivery of Health Care
Research

Keywords

  • Carcinoma, Squamous Cell/diagnostic imaging
  • Combined Modality Therapy
  • Cost-Benefit Analysis
  • Diagnostic Imaging/methods
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms/diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Population Surveillance
  • Prognosis
  • Technology Assessment, Biomedical/economics

Cite this

@article{79d48b95e77841b48db67b37874bf49b,
title = "The use of intensive radiological assessments in routine surveillance after treatment for head and neck cancer: An economic evaluation",
abstract = "BACKGROUND: There is uncertainty around the optimal surveillance of head and neck cancer patients after the primary curative treatment. This study aims at assessing the cost-effectiveness of a post-treatment programme of frequent radiological assessments (maximal approach) compared with a symptom-driven surveillance (minimal approach).MATERIALS AND METHODS: A decision-analytic Markov model is developed to assess the cost utility of two alternative follow-up programmes with a lifetime horizon. The two interventions differ in the number of radiological assessments (i.e. magnetic resonance imaging, computed tomography and positron-emission tomography) performed over a 5-year period. Clinical and utility parameters are derived from published and unpublished literature and expert opinion. The cost analysis is conducted from the perspective of a major Italian region's health care system. Cost-effectiveness results are expressed as incremental cost per life year gained (LYG) and per quality-adjusted life year (QALY) and checked against a cost-effectiveness threshold of €25,000-40,000 per QALY. One-way, two-way and probabilistic sensitivity analyses are carried out.RESULTS: In the base-case analysis, an intensive programme of radiological investigations leads to 0.10 additional QALYs (0.15 LYG) and an increase in costs of €1903 per patient compared with those of a minimal option, resulting in an incremental cost of €19,951/QALY gained (€13,123/LYG). In probabilistic sensitivity analysis, 72{\%} of the results lie below the €40,000 threshold (55{\%} below €25,000).CONCLUSIONS: An intensive post-treatment follow-up with scheduled radiological assessments over time might be cost-effective compared with symptom-driven surveillance in head and neck cancer patients. Further research is needed to check these results in empirical studies or real-world settings.",
keywords = "Carcinoma, Squamous Cell/diagnostic imaging, Combined Modality Therapy, Cost-Benefit Analysis, Diagnostic Imaging/methods, Female, Follow-Up Studies, Head and Neck Neoplasms/diagnostic imaging, Humans, Male, Middle Aged, Population Surveillance, Prognosis, Technology Assessment, Biomedical/economics",
author = "Michela Meregaglia and John Cairns and Lisa Licitra and Paolo Bossi",
note = "Copyright {\circledC} 2018 Elsevier Ltd. All rights reserved.",
year = "2018",
month = "4",
doi = "10.1016/j.ejca.2018.01.082",
language = "English",
volume = "93",
pages = "89--98",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Ltd",

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TY - JOUR

T1 - The use of intensive radiological assessments in routine surveillance after treatment for head and neck cancer

T2 - An economic evaluation

AU - Meregaglia, Michela

AU - Cairns, John

AU - Licitra, Lisa

AU - Bossi, Paolo

N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.

PY - 2018/4

Y1 - 2018/4

N2 - BACKGROUND: There is uncertainty around the optimal surveillance of head and neck cancer patients after the primary curative treatment. This study aims at assessing the cost-effectiveness of a post-treatment programme of frequent radiological assessments (maximal approach) compared with a symptom-driven surveillance (minimal approach).MATERIALS AND METHODS: A decision-analytic Markov model is developed to assess the cost utility of two alternative follow-up programmes with a lifetime horizon. The two interventions differ in the number of radiological assessments (i.e. magnetic resonance imaging, computed tomography and positron-emission tomography) performed over a 5-year period. Clinical and utility parameters are derived from published and unpublished literature and expert opinion. The cost analysis is conducted from the perspective of a major Italian region's health care system. Cost-effectiveness results are expressed as incremental cost per life year gained (LYG) and per quality-adjusted life year (QALY) and checked against a cost-effectiveness threshold of €25,000-40,000 per QALY. One-way, two-way and probabilistic sensitivity analyses are carried out.RESULTS: In the base-case analysis, an intensive programme of radiological investigations leads to 0.10 additional QALYs (0.15 LYG) and an increase in costs of €1903 per patient compared with those of a minimal option, resulting in an incremental cost of €19,951/QALY gained (€13,123/LYG). In probabilistic sensitivity analysis, 72% of the results lie below the €40,000 threshold (55% below €25,000).CONCLUSIONS: An intensive post-treatment follow-up with scheduled radiological assessments over time might be cost-effective compared with symptom-driven surveillance in head and neck cancer patients. Further research is needed to check these results in empirical studies or real-world settings.

AB - BACKGROUND: There is uncertainty around the optimal surveillance of head and neck cancer patients after the primary curative treatment. This study aims at assessing the cost-effectiveness of a post-treatment programme of frequent radiological assessments (maximal approach) compared with a symptom-driven surveillance (minimal approach).MATERIALS AND METHODS: A decision-analytic Markov model is developed to assess the cost utility of two alternative follow-up programmes with a lifetime horizon. The two interventions differ in the number of radiological assessments (i.e. magnetic resonance imaging, computed tomography and positron-emission tomography) performed over a 5-year period. Clinical and utility parameters are derived from published and unpublished literature and expert opinion. The cost analysis is conducted from the perspective of a major Italian region's health care system. Cost-effectiveness results are expressed as incremental cost per life year gained (LYG) and per quality-adjusted life year (QALY) and checked against a cost-effectiveness threshold of €25,000-40,000 per QALY. One-way, two-way and probabilistic sensitivity analyses are carried out.RESULTS: In the base-case analysis, an intensive programme of radiological investigations leads to 0.10 additional QALYs (0.15 LYG) and an increase in costs of €1903 per patient compared with those of a minimal option, resulting in an incremental cost of €19,951/QALY gained (€13,123/LYG). In probabilistic sensitivity analysis, 72% of the results lie below the €40,000 threshold (55% below €25,000).CONCLUSIONS: An intensive post-treatment follow-up with scheduled radiological assessments over time might be cost-effective compared with symptom-driven surveillance in head and neck cancer patients. Further research is needed to check these results in empirical studies or real-world settings.

KW - Carcinoma, Squamous Cell/diagnostic imaging

KW - Combined Modality Therapy

KW - Cost-Benefit Analysis

KW - Diagnostic Imaging/methods

KW - Female

KW - Follow-Up Studies

KW - Head and Neck Neoplasms/diagnostic imaging

KW - Humans

KW - Male

KW - Middle Aged

KW - Population Surveillance

KW - Prognosis

KW - Technology Assessment, Biomedical/economics

U2 - 10.1016/j.ejca.2018.01.082

DO - 10.1016/j.ejca.2018.01.082

M3 - Article

VL - 93

SP - 89

EP - 98

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

ER -