Cost-effectiveness analysis of salvage therapies in locoregional previously irradiated head and neck cancer.

Cost-effectiveness analysis of salvage therapies in locoregional previously irradiated head and neck cancer.

Head Neck. 2018 Mar 14;:

Authors: Kim H, Vargo JA, Beriwal S, Clump DA, Ohr JP, Ferris RL, Heron DE, Huq MS, Smith KJ

Abstract
BACKGROUND: The purpose of this study was to present our evaluation of the cost-effectiveness of salvage therapies for patients with recurrent head and neck cancer.
METHODS: A Markov model was developed with 5 salvage treatment strategies: (1) platinum-based chemotherapy alone; (2) chemotherapy plus cetuximab; (3) stereotactic body radiotherapy (SBRT) alone; (4) SBRT plus cetuximab; and (5) intensity-modulated radiotherapy (IMRT) plus chemotherapy. Clinical parameters were obtained from comprehensive literature review and 2016 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio (ICER), with effectiveness in quality-adjusted life years (QALYs), and evaluated with a willingness-to-pay (WTP) threshold of $100 000 per QALY gained.
RESULTS: In the base case analysis, no treatment strategy was cost-effective at a WTP threshold. The most cost-effective therapy was SBRT alone with $150 866 per QALY gained. If median survival of SBRT alone was ≥11 months, SBRT was considered to be cost-effective.
CONCLUSION: None of the treatment strategies were cost-effective. However, SBRT-based reirradiation has potential to be cost-effective.

PMID: 29537684 [PubMed - as supplied by publisher]

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