Cost-effectiveness analysis of (accelerated) pre-operative versus (conventional) post-operative radiotherapy for patients with oral cavity cancer in Sweden

Maria Silfverschiöld (), Kristin Carlwig, Johan Jarl, Lennart Greiff, Per Nilsson, Johan Wennerberg, Björn Zackrisson, Ellinor Östensson and Johanna Sjövall
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Maria Silfverschiöld: Skåne University Hospital
Kristin Carlwig: Skåne University Hospital
Johan Jarl: Lund University
Lennart Greiff: Skåne University Hospital
Per Nilsson: Lund University
Johan Wennerberg: Skåne University Hospital
Björn Zackrisson: Umeå University Hospital
Ellinor Östensson: Karolinska Institutet
Johanna Sjövall: Skåne University Hospital

The European Journal of Health Economics, 2024, vol. 25, issue 1, No 12, 177-185

Abstract: Abstract Background Treatment for resectable oral cavity cancer (OCC) often includes combinations of surgery and radiotherapy (RT), but there is no conclusive information on the preferred treatment order. The aim of this study was to assess the costs and cost-effectiveness of two alternative treatment regimens for patients with OCC, reflecting pre- and post-operative RT, from a societal perspective. Methods The study used data from the ARTSCAN 2 randomised controlled trial, which compares pre-operative accelerated RT with post-operative conventionally fractionated RT. Two-hundred-forty patients were included in the analysis of treatment outcomes. Direct costs were retrieved from the hospital’s economic systems, while indirect costs were obtained from national registries. Cost-effectiveness was assessed and a sensitivity analysis was performed. Overall survival (OS) at 5 years, was used as effect measure in the analysis. Results Two-hundred-nine patients completed the treatments and had retrievable data on costs. Mean direct costs (inpatient and outpatient care) were € 47,377 for pre-operative RT and € 39,841 for post-operative RT (p = 0.001), while corresponding indirect costs were € 19,854 and € 20,531 (p = 0.89). The incremental cost, i.e., the mean difference in total cost between the treatment regimens, was € 6859 paralleled with a 14-percentage point lower OS-rate at 5 years for pre-operative RT (i.e., 58 vs. 72%). Thus, pre-operative RT was dominated by post-operative RT. Conclusions From a societal perspective, post-operative RT for patients with resectable OCC is the dominant strategy compared to pre-operative RT.

Keywords: Head and neck cancer; Oral cavity cancer; Cost-effectiveness; Economic evaluation (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1007/s10198-023-01578-7

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