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Cost‐effectiveness analysis of salvage therapies in locoregional previously irradiated head and neck cancer
Author(s) -
Kim HaYeon,
Vargo John A.,
Beriwal Sushil,
Clump David A.,
Ohr James P.,
Ferris Robert L.,
Heron Dwight E.,
Huq M. Saiful,
Smith Kenneth J.
Publication year - 2018
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.25142
Subject(s) - medicine , head and neck cancer , cetuximab , radiation therapy , cost effectiveness , head and neck , chemotherapy , reimbursement , oncology , radiology , surgery , cancer , health care , risk analysis (engineering) , colorectal cancer , economics , economic growth
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.