Business Case for Pretreatment Swallowing Exercises

Abstract

Objective: Construct a decision analysis model to 1) estimate the incremental cost-effectiveness ratio (ICER) of pretreatment swallowing exercises to posttreatment swallowing exercises, and 2) propose a clinical decision-making tool to reduce head and neck cancer treatment-related morbidity.

Method: A transition state model was constructed to estimate the ICER of pretreatment swallowing exercises in 100 hypothetical patients with HNC treated with chemoradiation. Quality of life estimates were obtained through convenient sampling. Costs were estimated from Medicare reimbursement data. Sensitivity analyses evaluated changes in efficacy, utilities, and costs.

Results: Pretreatment swallowing exercises were less costly and resulted in a greater gain in quality-adjusted life-years (QALYs) when compared with posttreatment swallowing exercises. Compared with standard practice of providing posttreatment swallowing exercises, the pretreatment exercise intervention provides a dominant ICER of $142,972 and 15.88 QALYs per 100 patients. Sensitivity analysis adjusting both costs and utilities had minimal impact on these results as the ICER continued to be dominant, which suggests that pretreatment swallowing exercises are more effective and less expensive than posttreatment swallowing exercises.

Conclusion: Pretreatment swallowing exercises offer a clinical benefit in patients treated with chemoradiotherapy for head and neck cancer with significant cost savings relative to current standard of care. Findings from this analysis result in a useful decision-making tool for clinicians regarding prophylactic swallowing exercises to reduce treatment-related morbidity.