Cost-effectiveness analysis of radiotherapy for patients with Ledderhose disease
Anneke de Haan,
The Netherlands
OC-0754
Abstract
Cost-effectiveness analysis of radiotherapy for patients with Ledderhose disease
Authors: Anneke de Haan1, Henk Groen2, Johanna G.H. van Nes3, Peter-Paul van der Toorn4, A. Helen Westenberg5, M. Willemijn Kolff6, Paul M.N. Werker7, Johannes A. Langendijk1, Roel J.H.M. Steenbakkers1
1University Medical Center Groningen, Radiation Oncology, Groningen, The Netherlands; 2University Medical Center Groningen, Epidemiology, Groningen, The Netherlands; 3Radiotherapeutisch Instituut Friesland, Radiation Oncology, Leeuwarden, The Netherlands; 4Catharina Hospital , Radiation Oncology, Eindhoven, The Netherlands; 5Radiotherapiegroep, Radiation Oncology, Arnhem/Ede, The Netherlands; 6Amsterdam University Medical Center, Radiation Oncology, Amsterdam, The Netherlands; 7University Medical Center Groningen, Plastic Surgery, Groningen, The Netherlands
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Purpose or Objective
Radiotherapy is considered a treatment option for Ledderhose disease. Evidence for its effectiveness was found in the LedRad-study, a prospective multicentre randomized double-blind phase III clinical trial, comparing radiotherapy with sham-radiotherapy in patients with symptomatic Ledderhose disease (NCT03507010). However, the health economic impact of Ledderhose disease is unclear. To fill this knowledge gap, an economic evaluation alongside the LedRad-study was planned.
Material and Methods
The economic evaluation was performed as a cost-effectiveness and cost-utility analysis from the societal perspective. The outcome parameters for the economic evaluation were the pain score and quality of life (QoL) at 12 months after the end of treatment. Secondary analyses were performed with outcomes at 18 months. Pain scores from Ledderhose disease in the affected foot were measured with the Numeric Rating Scale (NRS). The validated EURO-QoL-5D-5L questionnaire was used to collect QoL data. For cost calculations, questionnaires were used to collect data regarding health care consumption inside and outside the hospital, travel and time costs, household support and informal care, out of pocket costs, and productivity loss. These questionnaires were completed simultaneously with pain and QoL measurements. Using the outcomes and cost data, incremental cost-effectiveness and cost-utility ratios were calculated to express costs per unit improvement in pain burden and costs per Quality Adjusted Life Years (QALY) gained for radiotherapy compared to sham-radiotherapy.
Results
In total 84 patients were enrolled in the LedRad-study. Previous analysis showed a significant improvement in pain- and QoL scores, at 12 and 18 months, in favor of the radiotherapy group. At these timepoints, cumulative total costs were considerably lower in the radiotherapy group, not including treatment costs. After the bootstrap replications, the incremental cost-effectiveness ratio (ICER) at 12 months after treatment based on pain burden was 1699.5 Euro per unit of pain burden reduction. With quality adjusted life-years as the outcome the incremental cost-utility ratio (ICUR) was 8286.7 Euro per QALY gained. The results of the bootstrap replications for pain burden and QALY are presented in Figures 1a and 1b. For both outcomes, most of the replications were in the upper left quadrant, indicating that health gain can be achieved at higher costs. The probability of cost-effectiveness gradually increased to approximately 85% (Figure 2).
Conclusion
In patients with Ledderhose disease, radiotherapy, for a certain degree of investment, is both clinically and economically effective.
