Cost-utility analysis of stereotactic body radiotherapy plus cetuximab in previously irradiated recurrent squamous cell carcinoma of the head and neck

ABSTRACT

Background

This study aimed to estimate the cost-utility of stereotactic body radiotherapy (SBRT) plus cetuximab for patients with previously irradiated recurrent squamous cell carcinoma of the head and neck.

Methods

We constructed a Markov health-state transition model to simulate costs and clinical outcomes of recurrent squamous cell carcinoma of the head and neck. Model parameters were derived from the published literature and the National Health Insurance Administration reimbursement price list. Incremental cost-effectiveness ratio and the net monetary benefit were calculated from a health payer perspective. The impact of uncertainty was modeled with one-way and probabilistic sensitivity analyses.

Results

In the base-case, SBRT plus cetuximab compared to SBRT alone resulted in an ICER of NT$ 840,455 per QALY gained. In the one-way sensitivity analysis, the utility of progression-free state for patients treated with SBRT plus cetuximab or SBRT alone and the cost of progression-free survival for SBRT+Cet were the most sensitive parameters in the model. Probabilistic sensitivity analysis showed that the probability of cost-effectiveness at a willingness-to-pay threshold of NT$ 2,252,340 per QALY was 100% for SBRT plus cetuximab but 0% for SBRT alone.

Conclusions

This study showed that SBRT+Cet was cost-effective and benefited patients with previously irradiated rSCCHN.

KEYWORDS:

• Cost-utility analysis
• net monetary benefit
• stereotactic body radiation therapy
• cetuximab
• squamous cell carcinoma of the head and neck

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Authors’ contributions

AC conceived the study, built the model, analyzed the data, and drafted the manuscript; HL participated in the study design, interpretation, and oncology expertise. JHL participated in data editing.

SW contributed in interpretation and expert opinion. HCL contributed to the statistics. All authors read and approved the final manuscript.

Ethics approval and consent to participate

This work did not require any written patient consent and the local ethics approval.

Consent for publication

Not applicable.

Availability of data and materials

The datasets supporting the conclusions of this article are included within the article.

Abbreviation: SBRT+Cet, stereotactic body radiation therapy; Cet, cetuximab QALY, quality-adjusted life-year. PFS, progression-free survival.

Additional information

Funding

This study was supported by the An Nan Hospital, China Medical University research fund.