Abstract
ObjectiveThere is limited evidence regarding the economic effects of nutrition support in cancer patients. This study aims at investigating the cost-effectiveness profile of systematic oral nutritional supplementation (ONS) in head and neck cancer (HNC) patients undergoing radiotherapy (RT) and receiving nutritional counseling.MethodsA cost-effectiveness analysis based on a RCT was performed to estimate direct medical costs, life years gained (LYG) and Quality-Adjusted Life Years (QALY) for nutritional counseling with or without ONS at 5-month and 6-year follow up time. Value of information analysis was performed to value the expected gain from reducing uncertainty through further data collection.ResultsONS with nutritional counseling produced higher QALY than nutritional counseling alone (0.291 ± 0.087 vs 0.288 ± 0.087), however the difference was not significant (0.0027, P = 0.84). Mean costs were €987.60 vs €996.09, respectively in the treatment and control group (-€8.96, P = 0.98). The Incremental Cost Effectiveness Ratio (ICER) was -€3,277/QALY, with 55.4% probabilities of being cost-effective at a cost-effectiveness threshold of €30,000/QALY. The Expected Incremental Benefit was €95.16 and the Population Expected Value of Perfect Information was €8.6 million, implying that additional research is likely to be worthwhile. At a median 6-year follow up, the treatment group had a significantly better survival rate when adjusting for late effect (P = 0.039).ConclusionOur findings provide the first evidence to inform decisions about funding and reimbursement of ONS in combination with nutritional counseling in HNC patients undergoing RT. ONS may improve quality of cancer care at no additional costs, however further research on the cost-effectiveness of nutritional supplementation is recommended.Trial Registration: ClinicalTrials.gov: NCT02055833. Registered 5th February 2014 https://clinicaltrials.gov/ct2/show/NCT02055833
Highlights
Malnutrition is a common clinical and public health problem that afflicts individuals both in community and hospital setting [1, 2]
What does the paper add to existing knowledge? This paper investigates the cost-effectiveness of oral nutritional supplementation (ONS) in combination with nutritional counseling in head and neck cancer (HNC) patients using individual patient data from a recent RCT at 5-month and 6-year follow up time
What insights does the paper provide for informing healthcare-related decision making? This study shows that neither differences in Quality-Adjusted Life Years (QALY) (0.0027, P = 0.84) nor costs (-€8.96, P = 0.98) were statistically significant
Summary
Malnutrition is a common clinical and public health problem that afflicts individuals both in community and hospital setting [1, 2]. Malnutrition is known to delay recovery from illness, to increase complications and dependency on others, to deteriorate quality of life and to extend length of stay [3]. Head and neck cancer (HNC) patients are at high risk of malnutrition [4,5,6,7], which has a negative effect on different clinical outcomes, including an impaired quality of life and a worse overall prognosis [6, 8]. Many cancer patients develop treatment-related toxicities that can cause or exacerbate symptoms, such as mucositis, xerostomia, alteration or loss of taste, fatigue, nausea and vomiting, which further increase the risk of malnutrition [9,10,11]. As a consequence of such toxicities, patients may suspend or reduce radiotherapy (RT) or systemic therapy (ST), which may cause poor clinical outcomes [9, 12, 13]
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