University of Twente Student Theses


A cost-effectiveness analysis of surgical versus organ-preserving treatment modalities for advanced laryngeal cancer

Meissner, Rosaly (2018) A cost-effectiveness analysis of surgical versus organ-preserving treatment modalities for advanced laryngeal cancer.

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Abstract:The treatment of advanced laryngeal cancer consists of surgical and organ-preserving modalities which are similar in overall survival but differ in intensity, duration and outcomes associated with rehabilitation and treatment. Also, treatment-related costs associated and quality of life outcomes vary amongst modalities. Therefore, the purpose was to determine the cost-effectiveness of surgery versus radiotherapy (RT), chemoradiotherapy (CRT) and bioradiotherapy (BRT) with the second aim to evaluate cost-effectiveness of BRT versus CRT to support decision-making in clinical practice. A Markov model has been constructed to compare surgery versus organ-preservation. A Monte Carlo Simulation of 1000 iterations was performed, based on costs and health outcomes. Treatment-related costs (including short term complications), costs of long-term occurring complications, rehabilitation, voice prosthesis and tube feeding were included. Outcomes were analyzed from a healthcare perspective, based on a lifetime horizon and were expressed by an incremental cost-effectiveness ratio (ICER) and illustrated by a cost-effectiveness (CE) plane and a cost-effectiveness acceptability curve (CEAC). Quality-adjusted life years (QALYs) gained were similar in TL (9,75) and RT (9,97). CRT and BRT gained QALYs of 7,75 and 8,76 respectively. BRT showed the largest amount of LYs gained with 13,7. The healthcare costs of TL were €73.612 versus €31.595 for RT. CRT and BRT resulted in costs of €55.971 and €61.058. The ICERs for TL versus RT, CRT and BRT were €-193.591, €8.816 and € 12.649. Comparing the cost-effectiveness of BRT to CRT resulted in an ICER of €5.044/QALY gained when treated with BRT. The analysis showed RT alone to be most cost-effective compared to surgery due to lowest costs. Although costs of BRT are higher than for RT, the ICER is far below the WTP threshold while a favorable outcome was shown in QALYs and LYs gained. This makes BRT relevant for clinical practice and supports the decision-making regarding reimbursement of organ-preserving modalities in advanced laryngeal cancer.
Item Type:Essay (Master)
Antoni van Leeuwenhoek, Amsterdam, Netherlands
Faculty:TNW: Science and Technology
Subject:44 medicine, 85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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