Skip to main content
Top
Published in: European Archives of Oto-Rhino-Laryngology 3/2016

01-03-2016 | Head and Neck

A cost-effectiveness analysis of using TheraBite in a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

Authors: Valesca P. Retèl, Lisette van der Molen, Lotte M. G. Steuten, Michiel W. van den Brekel, Frans J. M. Hilgers

Published in: European Archives of Oto-Rhino-Laryngology | Issue 3/2016

Login to get access

Abstract

Previous studies have shown that a “Preventive Exercise Program” (PREP) is cost-effective compared to the standard exercise program provided in “Usual Care” (UC) in patients with advanced head and neck cancer. The current paper specifically estimates the cost-effectiveness of the TheraBite jaw rehabilitation device (TB) which is used as part of the PREP, compared to Speech Language Pathology (SLP) sessions as part of UC, and herewith intents to inform reimbursement discussions regarding the TheraBite device. Costs and outcomes [quality-adjusted life-years (QALYs)] of the TB compared to SLP were estimated using a Markov model of advanced head and neck cancer patients. Secondary outcome variables were trismus, feeding substitutes, facial pain, and pneumonia. The incremental cost-effectiveness ratio (ICER) was estimated from a health care perspective of the Netherlands, with a time horizon of 2 years. The total health care costs per patient were estimated to amount to €5,129 for the TB strategy and €6,915 for the SLP strategy. Based on the current data, the TB strategy yielded more quality-adjusted life-years (1.28) compared to the SLP strategy (1.24). Thus, the TB strategy seems more effective (+0.04) and less costly (−€1,786) than the SLP only strategy. At the prevailing threshold of €20,000/QALY the probability for the TB strategy being cost-effective compared to SLP was 70 %. To conclude, analysis of presently available data indicates that TB is expected to be cost-effective compared to SLP in a preventive exercise program for concomitant chemo-radiotherapy for advanced head and neck cancer patients.
Literature
1.
go back to reference Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R (2012) “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys 83:210–219CrossRefPubMed Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R (2012) “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys 83:210–219CrossRefPubMed
2.
go back to reference van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ (2011) A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia 26:155–170PubMedCentralCrossRefPubMed van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ (2011) A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia 26:155–170PubMedCentralCrossRefPubMed
3.
go back to reference Dijkstra PU, Huisman PM, Roodenburg JL (2006) Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg 35:337–342CrossRefPubMed Dijkstra PU, Huisman PM, Roodenburg JL (2006) Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg 35:337–342CrossRefPubMed
4.
go back to reference Dijkstra PU, Sterken MW, Pater R, Spijkervet FK, Roodenburg JL (2007) Exercise therapy for trismus in head and neck cancer. Oral Oncol 43:389–394CrossRefPubMed Dijkstra PU, Sterken MW, Pater R, Spijkervet FK, Roodenburg JL (2007) Exercise therapy for trismus in head and neck cancer. Oral Oncol 43:389–394CrossRefPubMed
5.
go back to reference Dijkstra PU, Kalk WW, Roodenburg JL (2004) Trismus in head and neck oncology: a systematic review. Oral Oncol 40:879–889CrossRefPubMed Dijkstra PU, Kalk WW, Roodenburg JL (2004) Trismus in head and neck oncology: a systematic review. Oral Oncol 40:879–889CrossRefPubMed
6.
go back to reference Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D (1999) Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck 21:1–11CrossRefPubMed Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D (1999) Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck 21:1–11CrossRefPubMed
7.
go back to reference Krennmair G, Ulm CW, Lenglinger F (2000) Effects of reduced mouth opening capacity (trismus) on pulmonary function. Int J Oral Maxillofac Surg 29:351–354CrossRefPubMed Krennmair G, Ulm CW, Lenglinger F (2000) Effects of reduced mouth opening capacity (trismus) on pulmonary function. Int J Oral Maxillofac Surg 29:351–354CrossRefPubMed
8.
go back to reference Buchbinder D, Currivan RB, Kaplan AJ, Urken ML (1993) Mobilization regimens for the prevention of jaw hypomobility in the radiated patient: a comparison of three techniques. J Oral Maxillofac Surg 51:863–867CrossRefPubMed Buchbinder D, Currivan RB, Kaplan AJ, Urken ML (1993) Mobilization regimens for the prevention of jaw hypomobility in the radiated patient: a comparison of three techniques. J Oral Maxillofac Surg 51:863–867CrossRefPubMed
9.
go back to reference Cohen EG, Deschler DG, Walsh K, Hayden RE (2005) Early use of a mechanical stretching device to improve mandibular mobility after composite resection: a pilot study. Arch Phys Med Rehabil 86:1416–1419CrossRefPubMed Cohen EG, Deschler DG, Walsh K, Hayden RE (2005) Early use of a mechanical stretching device to improve mandibular mobility after composite resection: a pilot study. Arch Phys Med Rehabil 86:1416–1419CrossRefPubMed
10.
go back to reference Kamstra JI, Roodenburg JL, Beurskens CH, Reintsema H, Dijkstra PU (2013) TheraBite exercises to treat trismus secondary to head and neck cancer. Support Care Cancer 21:951–957PubMedCentralCrossRefPubMed Kamstra JI, Roodenburg JL, Beurskens CH, Reintsema H, Dijkstra PU (2013) TheraBite exercises to treat trismus secondary to head and neck cancer. Support Care Cancer 21:951–957PubMedCentralCrossRefPubMed
11.
go back to reference Burkhead LM, Sapienza CM, Rosenbek JC (2007) Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia 22:251–265CrossRefPubMed Burkhead LM, Sapienza CM, Rosenbek JC (2007) Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia 22:251–265CrossRefPubMed
12.
go back to reference Retel VP, van der Molen L, Hilgers FJ, Rasch CR, L’Ortye AA, Steuten LM, van Harten WH (2011) A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy. BMC Cancer 11:475PubMedCentralCrossRefPubMed Retel VP, van der Molen L, Hilgers FJ, Rasch CR, L’Ortye AA, Steuten LM, van Harten WH (2011) A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy. BMC Cancer 11:475PubMedCentralCrossRefPubMed
13.
go back to reference van der Molen L, van Rossum MA, Rasch CR, Smeele LE, Hilgers FJ (2013) Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otorhinolaryngol 271(5):1257–1270CrossRefPubMed van der Molen L, van Rossum MA, Rasch CR, Smeele LE, Hilgers FJ (2013) Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otorhinolaryngol 271(5):1257–1270CrossRefPubMed
14.
go back to reference Ackerstaff AH, Balm AJ, Rasch CR, de Boer JP, Wiggenraad R, Rietveld DH, Gregor RT, Kroger R, Hilgers FJ (2009) First-year quality of life assessment of an intra-arterial (RADPLAT) versus intravenous chemoradiation phase III trial. Head Neck 31:77–84CrossRefPubMed Ackerstaff AH, Balm AJ, Rasch CR, de Boer JP, Wiggenraad R, Rietveld DH, Gregor RT, Kroger R, Hilgers FJ (2009) First-year quality of life assessment of an intra-arterial (RADPLAT) versus intravenous chemoradiation phase III trial. Head Neck 31:77–84CrossRefPubMed
15.
go back to reference Rasch CR, Hauptmann M, Schornagel J, Wijers O, Buter J, Gregor T, Wiggenraad R, de Boer JP, Ackerstaff AH, Kroger R, Hoebers FJ, Balm AJ, Hilgers FJ (2010) Intra-arterial versus intravenous chemoradiation for advanced head and neck cancer: results of a randomized phase 3 trial. Cancer 116:2159–2165CrossRefPubMed Rasch CR, Hauptmann M, Schornagel J, Wijers O, Buter J, Gregor T, Wiggenraad R, de Boer JP, Ackerstaff AH, Kroger R, Hoebers FJ, Balm AJ, Hilgers FJ (2010) Intra-arterial versus intravenous chemoradiation for advanced head and neck cancer: results of a randomized phase 3 trial. Cancer 116:2159–2165CrossRefPubMed
16.
go back to reference Bleichrodt H, Quiggin J (1999) Life-cycle preferences over consumption and health: when is cost-effectiveness analysis equivalent to cost-benefit analysis? J Health Econ 18:681–708CrossRefPubMed Bleichrodt H, Quiggin J (1999) Life-cycle preferences over consumption and health: when is cost-effectiveness analysis equivalent to cost-benefit analysis? J Health Econ 18:681–708CrossRefPubMed
17.
go back to reference Torrance GW, Feeny D (1989) Utilities and quality-adjusted life years. Int J Technol Assess Health Care 5:559–575CrossRefPubMed Torrance GW, Feeny D (1989) Utilities and quality-adjusted life years. Int J Technol Assess Health Care 5:559–575CrossRefPubMed
18.
go back to reference Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952CrossRefPubMed Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952CrossRefPubMed
19.
go back to reference Nguyen NP, Vos P, Moltz CC, Frank C, Millar C, Smith HJ, Dutta S, Alfieri A, Lee H, Martinez T, Karlsson U, Nguyen LM, Sallah S (2008) Analysis of the factors influencing dysphagia severity upon diagnosis of head and neck cancer. Br J Radiol 81:706–710CrossRefPubMed Nguyen NP, Vos P, Moltz CC, Frank C, Millar C, Smith HJ, Dutta S, Alfieri A, Lee H, Martinez T, Karlsson U, Nguyen LM, Sallah S (2008) Analysis of the factors influencing dysphagia severity upon diagnosis of head and neck cancer. Br J Radiol 81:706–710CrossRefPubMed
20.
go back to reference Langerman A, Maccracken E, Kasza K, Haraf DJ, Vokes EE, Stenson KM (2007) Aspiration in chemoradiated patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 133:1289–1295CrossRefPubMed Langerman A, Maccracken E, Kasza K, Haraf DJ, Vokes EE, Stenson KM (2007) Aspiration in chemoradiated patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 133:1289–1295CrossRefPubMed
21.
go back to reference Hakkaart-van Roijen L, Tan SS, Bouwmans-Frijters CAM (2010) Guide for research costs - Methods and standard cost prices for economic evaluations in healthcare \ commissioned by the Health Care Insurance Board. Rotterdam Hakkaart-van Roijen L, Tan SS, Bouwmans-Frijters CAM (2010) Guide for research costs - Methods and standard cost prices for economic evaluations in healthcare \ commissioned by the Health Care Insurance Board. Rotterdam
22.
go back to reference Sorgente, accessed September 2014: https://webwinkelsorgentel/indexphp?id_product=1010&controller=product Sorgente, accessed September 2014: https://​webwinkelsorgent​el/​indexphp?​id_​product=​1010&​controller=​product
23.
go back to reference Pauli N, Fagerberg-Mohlin B, Andrell P, Finizia C (2013) Exercise intervention for the treatment of trismus in head and neck cancer. Acta Oncol 53(4):502–509CrossRefPubMed Pauli N, Fagerberg-Mohlin B, Andrell P, Finizia C (2013) Exercise intervention for the treatment of trismus in head and neck cancer. Acta Oncol 53(4):502–509CrossRefPubMed
24.
go back to reference Ramaekers BL, Joore MA, Grutters JP, van den Ende P, Jong J, Houben R, Lambin P, Christianen M, Beetz I, Pijls-Johannesma M, Langendijk JA (2011) The impact of late treatment-toxicity on generic health-related quality of life in head and neck cancer patients after radiotherapy. Oral Oncol 47:768–774CrossRefPubMed Ramaekers BL, Joore MA, Grutters JP, van den Ende P, Jong J, Houben R, Lambin P, Christianen M, Beetz I, Pijls-Johannesma M, Langendijk JA (2011) The impact of late treatment-toxicity on generic health-related quality of life in head and neck cancer patients after radiotherapy. Oral Oncol 47:768–774CrossRefPubMed
25.
go back to reference Elia M, Stratton RJ (2008) A cost-utility analysis in patients receiving enteral tube feeding at home and in nursing homes. Clin Nutr 27:416–423CrossRefPubMed Elia M, Stratton RJ (2008) A cost-utility analysis in patients receiving enteral tube feeding at home and in nursing homes. Clin Nutr 27:416–423CrossRefPubMed
26.
go back to reference Weinstein MC (2006) Recent developments in decision-analytic modelling for economic evaluation. Pharmacoeconomics 24:1043–1053CrossRefPubMed Weinstein MC (2006) Recent developments in decision-analytic modelling for economic evaluation. Pharmacoeconomics 24:1043–1053CrossRefPubMed
27.
go back to reference Fenwick E, Claxton K, Sculpher M (2001) Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ 10:779–787CrossRefPubMed Fenwick E, Claxton K, Sculpher M (2001) Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ 10:779–787CrossRefPubMed
28.
go back to reference Briggs A, Claxton K, Sculpher M (2006) Decicion modelling for health economic evaluation. Oxford University Press, UK Briggs A, Claxton K, Sculpher M (2006) Decicion modelling for health economic evaluation. Oxford University Press, UK
29.
go back to reference Pauli N, Johnson J, Finizia C, Andrell P (2013) The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer. Acta Oncol 52:1137–1145CrossRefPubMed Pauli N, Johnson J, Finizia C, Andrell P (2013) The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer. Acta Oncol 52:1137–1145CrossRefPubMed
30.
go back to reference Gourin CG, Couch ME, Johnson JT (2014) Effect of weight loss on short-term outcomes and costs of care after head and neck cancer surgery. Ann Otol Rhinol Laryngol 123:101–110CrossRefPubMed Gourin CG, Couch ME, Johnson JT (2014) Effect of weight loss on short-term outcomes and costs of care after head and neck cancer surgery. Ann Otol Rhinol Laryngol 123:101–110CrossRefPubMed
31.
go back to reference Melchers LJ, Van WE, Beurskens CH, Reintsema H, Slagter AP, Roodenburg JL, Dijkstra PU (2009) Exercise adherence in patients with trismus due to head and neck oncology: a qualitative study into the use of the Therabite. Int J Oral Maxillofac Surg 38:947–954CrossRefPubMed Melchers LJ, Van WE, Beurskens CH, Reintsema H, Slagter AP, Roodenburg JL, Dijkstra PU (2009) Exercise adherence in patients with trismus due to head and neck oncology: a qualitative study into the use of the Therabite. Int J Oral Maxillofac Surg 38:947–954CrossRefPubMed
32.
go back to reference Pauli N, Andrell P, Johansson M, Fagerberg-Mohlin B, Finizia C (2014) Treating trismus: a prospective study on effect and compliance to jaw exercise therapy in head and neck cancer. Head Neck. doi:10.1002/hed.23818 Pauli N, Andrell P, Johansson M, Fagerberg-Mohlin B, Finizia C (2014) Treating trismus: a prospective study on effect and compliance to jaw exercise therapy in head and neck cancer. Head Neck. doi:10.​1002/​hed.​23818
Metadata
Title
A cost-effectiveness analysis of using TheraBite in a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy
Authors
Valesca P. Retèl
Lisette van der Molen
Lotte M. G. Steuten
Michiel W. van den Brekel
Frans J. M. Hilgers
Publication date
01-03-2016
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 3/2016
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-015-3541-9

Other articles of this Issue 3/2016

European Archives of Oto-Rhino-Laryngology 3/2016 Go to the issue