Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer

A. F. Smith; P. S. Hall; C. T. Hulme; J. A. Dunn; C. C. McConkey; J. K. Rahman; C. McCabe; Hesham Mehanna

doi:10.1016/j.ejca.2017.07.054

Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer

A. F. Smith, P. S. Hall, C. T. Hulme, J. A. Dunn, C. C. McConkey, J. K. Rahman, C. McCabe, Hesham Mehanna

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

Abstract

BACKGROUND: A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective.

METHODS: Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results.

RESULTS: PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective.

CONCLUSIONS: This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption.

Original language	English
Pages (from-to)	6-14
Number of pages	9
Journal	European Journal of Cancer
Volume	85
Early online date	4 Sept 2017
DOIs	https://doi.org/10.1016/j.ejca.2017.07.054
Publication status	Published - 1 Nov 2017

Keywords

Models
Economic
Positron emission tomography–computed tomography
Head and neck neoplasms
Technology assessment
Biomedical
Cost-benefit analysis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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http://www.sciencedirect.com/science/article/pii/S0959804917312029Licence: None: All rights reserved

Cite this

@article{79b26acfde4a4f38bd30072e05f4e632,

title = "Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer",

abstract = "BACKGROUND: A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective.METHODS: Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results.RESULTS: PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective.CONCLUSIONS: This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption.",

keywords = "Models, Economic, Positron emission tomography–computed tomography, Head and neck neoplasms, Technology assessment, Biomedical, Cost-benefit analysis",

author = "Smith, {A. F.} and Hall, {P. S.} and Hulme, {C. T.} and Dunn, {J. A.} and McConkey, {C. C.} and Rahman, {J. K.} and C. McCabe and Hesham Mehanna",

year = "2017",

month = nov,

day = "1",

doi = "10.1016/j.ejca.2017.07.054",

language = "English",

volume = "85",

pages = "6--14",

journal = "European Journal of Cancer",

issn = "0959-8049",

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TY - JOUR

T1 - Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer

AU - Smith, A. F.

AU - Hall, P. S.

AU - Hulme, C. T.

AU - Dunn, J. A.

AU - McConkey, C. C.

AU - Rahman, J. K.

AU - McCabe, C.

AU - Mehanna, Hesham

PY - 2017/11/1

Y1 - 2017/11/1

N2 - BACKGROUND: A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective.METHODS: Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results.RESULTS: PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective.CONCLUSIONS: This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption.

AB - BACKGROUND: A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective.METHODS: Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results.RESULTS: PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective.CONCLUSIONS: This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption.

KW - Models

KW - Economic

KW - Positron emission tomography–computed tomography

KW - Head and neck neoplasms

KW - Technology assessment

KW - Biomedical

KW - Cost-benefit analysis

U2 - 10.1016/j.ejca.2017.07.054

DO - 10.1016/j.ejca.2017.07.054

M3 - Article

C2 - 28881249

SN - 0959-8049

VL - 85

SP - 6

EP - 14

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer

Abstract

Keywords

UN SDGs

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