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Cost-effectiveness analysis of voice rehabilitation for patients with laryngeal cancer: a randomized controlled study

Journal article
Authors Mia Johansson
Caterina Finizia
Josefine Persson
Lisa Tuomi
Published in Supportive Care in Cancer
Pages 9
ISSN 0941-4355
Publication year 2020
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Clinical Sciences, Department of Oncology
Institute of Clinical Sciences, Department of Otorhinolaryngology
Pages 9
Language en
Links dx.doi.org/10.1007/s00520-020-05362...
Keywords Laryngeal neoplasms, Voice therapy, Costs, Cost-effectiveness, Radiotherapy, Quality of life, quality-of-life, early glottic cancer, eortc qlq-c30, radiotherapy, eq-5d, efficacy, therapy, head, communication, questionnaire, Oncology, Health Care Sciences & Services, Rehabilitation
Subject categories Nursing, Otorhinolaryngology

Abstract

Introduction Voice problems are common following radiotherapy for laryngeal cancer. Few studies exist covering the effect of voice rehabilitation, and no previous studies exist regarding the cost of said rehabilitation. This randomized controlled study aimed to analyze the cost-effectiveness of voice rehabilitation after radiotherapy for patients with laryngeal cancer. Material and methods A total of 66 patients with laryngeal cancer with follow-up data 12 months post-radiotherapy were included. Patients were randomized into receiving either voice rehabilitation (n = 32) or no voice rehabilitation (n = 34). The patient outcome was measured as quality-adjusted life years (QALYs). The index range between 0 and 1, where 0 equals death and 1 represents perfect health. The QALYs were assessed with the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30 mapped to EuroQoL 5 Dimension values. The cost of rehabilitation and other healthcare visits was derived from hospital systems. The patients reported the total amount of sick leave days during the first 12 months following radiotherapy. The cost-effectiveness of the voice rehabilitation was compared with no rehabilitation intervention based on the incremental cost-effectiveness ratio. Results The cost per gained QALY with voice rehabilitation compared to no rehabilitation from a societal perspective was - 27,594 euro (SEK - 250,852) which indicates that the voice rehabilitation is a cost-saving alternative compared to no rehabilitation due to lower costs and a slightly better health outcome. From a healthcare perspective, the voice rehabilitation indicates a cost 60,800 euro (SEK 552,725) per gained QALY. Conclusion From a societal perspective, i.e., including the costs of production loss, voice rehabilitation compared to no voice rehabilitation following radiotherapy for laryngeal cancer seems to be cost-saving. When analyzing only the healthcare costs in relation to health outcomes, voice rehabilitation indicates an incremental cost of 60,800 euro per gained QALY, which is just above the threshold of the maximum willingness to pay level.

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