Cost-effectiveness analysis of oral nutritional supplements with nutritional counselling in head and neck cancer patients undergoing radiotherapy

Beatrice Martin, Emanuele Cereda, Riccardo Caccialanza, Paolo Pedrazzoli, Rosanna Tarricone, Oriana Ciani, Beatrice Martin, Emanuele Cereda, Riccardo Caccialanza, Paolo Pedrazzoli, Rosanna Tarricone, Oriana Ciani

Abstract

Objective: There 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.

Methods: A 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.

Results: ONS 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).

Conclusion: Our 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://ichgcp.net/clinical-trials-registry/NCT02055833.

Conflict of interest statement

BM, OC, RT, PP declare no conflict of interest in relation to this study. RC and EC has served in advisory boards for Nestlè Health Science.

Figures

Fig. 1
Fig. 1
Utility profile of treatment (ONS + nutritional counseling) and control (nutritional counseling) group
Fig. 2
Fig. 2
Cost Effectiveness Plane (on the left) at a WTP = €30,000/QALY and Acceptability Curve (on the right)
Fig. 3
Fig. 3
Survival curves of treatment and control group

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