Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial

Femke Jansen; Veerle M.H. Coupé; Simone E.J. Eerenstein; Ingrid C. Cnossen; Cornelia F. van Uden-Kraan; Remco de Bree; Patricia Doornaert; György B. Halmos; José A.U. Hardillo; Gerben van Hinte; Jimmie Honings; C. René Leemans; Irma M. Verdonck-de Leeuw

doi:10.1016/j.oraloncology.2021.105306

Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial

Femke Jansen^*, Veerle M.H. Coupé, Simone E.J. Eerenstein, Ingrid C. Cnossen, Cornelia F. van Uden-Kraan, Remco de Bree, Patricia Doornaert, György B. Halmos, José A.U. Hardillo, Gerben van Hinte, Jimmie Honings, C. René Leemans, Irma M. Verdonck-de Leeuw

^*Corresponding author for this work

Otorhinolaryngology and Head and Neck Surgery

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

4 Citations (Scopus)

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Abstract

Objectives: The guided self-help exercise program called In Tune without Cords (ITwC) is effective in improving swallowing problems and communication among patients treated with a total laryngectomy (TL). This study investigated the cost-utility and cost-effectiveness of ITwC.

Materials and methods: Patients within 5 years after TL were included in this randomized controlled trial. Patients in the intervention group (n = 46) received access to the self-help exercise program with flexibility, range-of-motion and lymphedema exercises, and a self-care education program. Patients in the control group (n = 46) received access to the self-care education program only. Healthcare utilization (iMCQ), productivity losses (iPCQ), health status (EQ-5D-3L, EORTC QLU-C10D) and swallowing problems (SwalQol) were measured at baseline, 3- and 6-months follow-up. Hospital costs were extracted from medical files. Mean total costs and effects (quality-adjusted life-years (QALYs) or SwalQol score) were compared with regression analyses using bias-corrected accelerated bootstrapping.

Results: Mean total costs were non-significantly lower (-€685) and QALYs were significantly higher (+0.06) in the intervention compared to the control group. The probability that the intervention is less costly and more effective was 73%. Sensitivity analyses with adjustment for baseline costs and EQ-5D scores showed non-significantly higher costs (+€119 to +€364) and QALYs (+0.02 to +0.03). A sensitivity analysis using the QLU-C10D to calculate QALYs showed higher costs (+€741) and lower QALYs (-0.01) and an analysis that used the SwalQol showed higher costs (+€232) and higher effects (improvement of 6 points on a 0–100 scale).

Conclusion: ITwC is likely to be effective, but possibly at higher expenses. Trial Registration: NTR5255.

Original language	English
Article number	105306
Journal	Oral Oncology
Volume	117
Early online date	24 Apr 2021
DOIs	https://doi.org/10.1016/j.oraloncology.2021.105306
Publication status	Published - Jun 2021

Bibliographical note

Funding Information:
This research is supported by grants from the Michel Keijzer Fund. The Michel Keijzer Fund had no role in the design of the study, data collection, analysis, and interpretation of data and in writing the manuscript.

Publisher Copyright:
© 2021 The Authors

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Cite this

Jansen, F., Coupé, V. M. H., Eerenstein, S. E. J., Cnossen, I. C., van Uden-Kraan, C. F., de Bree, R., Doornaert, P., Halmos, G. B., Hardillo, J. A. U., van Hinte, G., Honings, J., Leemans, C. R., & Verdonck-de Leeuw, I. M. (2021). Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial. Oral Oncology, 117, [105306]. https://doi.org/10.1016/j.oraloncology.2021.105306

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title = "Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial",

abstract = "Objectives: The guided self-help exercise program called In Tune without Cords (ITwC) is effective in improving swallowing problems and communication among patients treated with a total laryngectomy (TL). This study investigated the cost-utility and cost-effectiveness of ITwC. Materials and methods: Patients within 5 years after TL were included in this randomized controlled trial. Patients in the intervention group (n = 46) received access to the self-help exercise program with flexibility, range-of-motion and lymphedema exercises, and a self-care education program. Patients in the control group (n = 46) received access to the self-care education program only. Healthcare utilization (iMCQ), productivity losses (iPCQ), health status (EQ-5D-3L, EORTC QLU-C10D) and swallowing problems (SwalQol) were measured at baseline, 3- and 6-months follow-up. Hospital costs were extracted from medical files. Mean total costs and effects (quality-adjusted life-years (QALYs) or SwalQol score) were compared with regression analyses using bias-corrected accelerated bootstrapping. Results: Mean total costs were non-significantly lower (-€685) and QALYs were significantly higher (+0.06) in the intervention compared to the control group. The probability that the intervention is less costly and more effective was 73%. Sensitivity analyses with adjustment for baseline costs and EQ-5D scores showed non-significantly higher costs (+€119 to +€364) and QALYs (+0.02 to +0.03). A sensitivity analysis using the QLU-C10D to calculate QALYs showed higher costs (+€741) and lower QALYs (-0.01) and an analysis that used the SwalQol showed higher costs (+€232) and higher effects (improvement of 6 points on a 0–100 scale). Conclusion: ITwC is likely to be effective, but possibly at higher expenses. Trial Registration: NTR5255.",

author = "Femke Jansen and Coup{\'e}, {Veerle M.H.} and Eerenstein, {Simone E.J.} and Cnossen, {Ingrid C.} and {van Uden-Kraan}, {Cornelia F.} and {de Bree}, Remco and Patricia Doornaert and Halmos, {Gy{\"o}rgy B.} and Hardillo, {Jos{\'e} A.U.} and {van Hinte}, Gerben and Jimmie Honings and Leemans, {C. Ren{\'e}} and {Verdonck-de Leeuw}, {Irma M.}",

note = "Funding Information: This research is supported by grants from the Michel Keijzer Fund. The Michel Keijzer Fund had no role in the design of the study, data collection, analysis, and interpretation of data and in writing the manuscript. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = jun,

doi = "10.1016/j.oraloncology.2021.105306",

language = "English",

volume = "117",

journal = "Oral Oncology",

issn = "1368-8375",

publisher = "Elsevier Ltd.",

}

Jansen, F, Coupé, VMH, Eerenstein, SEJ, Cnossen, IC, van Uden-Kraan, CF, de Bree, R, Doornaert, P, Halmos, GB, Hardillo, JAU, van Hinte, G, Honings, J, Leemans, CR & Verdonck-de Leeuw, IM 2021, 'Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial', Oral Oncology, vol. 117, 105306. https://doi.org/10.1016/j.oraloncology.2021.105306

Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial. / Jansen, Femke; Coupé, Veerle M.H.; Eerenstein, Simone E.J. et al.
In: Oral Oncology, Vol. 117, 105306, 06.2021.

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

TY - JOUR

T1 - Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy

T2 - Results of a multi-center randomized controlled trial

AU - Jansen, Femke

AU - Coupé, Veerle M.H.

AU - Eerenstein, Simone E.J.

AU - Cnossen, Ingrid C.

AU - van Uden-Kraan, Cornelia F.

AU - de Bree, Remco

AU - Doornaert, Patricia

AU - Halmos, György B.

AU - Hardillo, José A.U.

AU - van Hinte, Gerben

AU - Honings, Jimmie

AU - Leemans, C. René

AU - Verdonck-de Leeuw, Irma M.

N1 - Funding Information: This research is supported by grants from the Michel Keijzer Fund. The Michel Keijzer Fund had no role in the design of the study, data collection, analysis, and interpretation of data and in writing the manuscript. Publisher Copyright: © 2021 The Authors

PY - 2021/6

Y1 - 2021/6

N2 - Objectives: The guided self-help exercise program called In Tune without Cords (ITwC) is effective in improving swallowing problems and communication among patients treated with a total laryngectomy (TL). This study investigated the cost-utility and cost-effectiveness of ITwC. Materials and methods: Patients within 5 years after TL were included in this randomized controlled trial. Patients in the intervention group (n = 46) received access to the self-help exercise program with flexibility, range-of-motion and lymphedema exercises, and a self-care education program. Patients in the control group (n = 46) received access to the self-care education program only. Healthcare utilization (iMCQ), productivity losses (iPCQ), health status (EQ-5D-3L, EORTC QLU-C10D) and swallowing problems (SwalQol) were measured at baseline, 3- and 6-months follow-up. Hospital costs were extracted from medical files. Mean total costs and effects (quality-adjusted life-years (QALYs) or SwalQol score) were compared with regression analyses using bias-corrected accelerated bootstrapping. Results: Mean total costs were non-significantly lower (-€685) and QALYs were significantly higher (+0.06) in the intervention compared to the control group. The probability that the intervention is less costly and more effective was 73%. Sensitivity analyses with adjustment for baseline costs and EQ-5D scores showed non-significantly higher costs (+€119 to +€364) and QALYs (+0.02 to +0.03). A sensitivity analysis using the QLU-C10D to calculate QALYs showed higher costs (+€741) and lower QALYs (-0.01) and an analysis that used the SwalQol showed higher costs (+€232) and higher effects (improvement of 6 points on a 0–100 scale). Conclusion: ITwC is likely to be effective, but possibly at higher expenses. Trial Registration: NTR5255.

AB - Objectives: The guided self-help exercise program called In Tune without Cords (ITwC) is effective in improving swallowing problems and communication among patients treated with a total laryngectomy (TL). This study investigated the cost-utility and cost-effectiveness of ITwC. Materials and methods: Patients within 5 years after TL were included in this randomized controlled trial. Patients in the intervention group (n = 46) received access to the self-help exercise program with flexibility, range-of-motion and lymphedema exercises, and a self-care education program. Patients in the control group (n = 46) received access to the self-care education program only. Healthcare utilization (iMCQ), productivity losses (iPCQ), health status (EQ-5D-3L, EORTC QLU-C10D) and swallowing problems (SwalQol) were measured at baseline, 3- and 6-months follow-up. Hospital costs were extracted from medical files. Mean total costs and effects (quality-adjusted life-years (QALYs) or SwalQol score) were compared with regression analyses using bias-corrected accelerated bootstrapping. Results: Mean total costs were non-significantly lower (-€685) and QALYs were significantly higher (+0.06) in the intervention compared to the control group. The probability that the intervention is less costly and more effective was 73%. Sensitivity analyses with adjustment for baseline costs and EQ-5D scores showed non-significantly higher costs (+€119 to +€364) and QALYs (+0.02 to +0.03). A sensitivity analysis using the QLU-C10D to calculate QALYs showed higher costs (+€741) and lower QALYs (-0.01) and an analysis that used the SwalQol showed higher costs (+€232) and higher effects (improvement of 6 points on a 0–100 scale). Conclusion: ITwC is likely to be effective, but possibly at higher expenses. Trial Registration: NTR5255.

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DO - 10.1016/j.oraloncology.2021.105306

M3 - Article

C2 - 33905913

AN - SCOPUS:85104819576

SN - 1368-8375

VL - 117

JO - Oral Oncology

JF - Oral Oncology

M1 - 105306

ER -

Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial

Abstract

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