Economic Analysis of a Three-Arm RCT Exploring the Delivery of Intensive, Prophylactic Swallowing Therapy to Patients with Head and Neck Cancer During (Chemo)Radiotherapy

Abstract

Research advocates for the use of intensive, prophylactic swallowing therapy to help reduce the severity of dysphagia in patients receiving (chemo)radiotherapy ([C]RT) for head/neck cancer (HNC). Unfortunately, the intensity of this therapy, coupled with growing patient numbers and limited clinical resources, provides challenges to many international cancer facilities. Telepractice has been proposed as a potential method to provide patients with greater support in home-practice, whilst minimising burden to the health service. This study investigated the clinical and patient-attributable costs of delivering an intensive, prophylactic swallowing therapy protocol via a new telepractice application “SwallowIT” as compared to clinician-directed FTF therapy and independent patient self-directed therapy. Patients (n = 79) with oropharyngeal HNC receiving definitive (C)RT were randomised to receive therapy via a: clinician-directed (n = 26), patient-directed (n = 27), or SwallowIT-assisted (n = 26) model of care. Data pertaining to health service costs (service time, consumables, therapy resources), patient-attributable costs (travel and wages) and patient-reported health-related quality of life (QoL) (AQoL-6D) were collected. SwallowIT provided a cost-efficient model of care when compared to the clinician-directed model, with significant cost savings to both the health service and to HNC consumers (total saving of $1901.10 AUD per patient; p < 0.001). The SwallowIT model also proved more cost-effective than the patient-directed model, yielding clinically significantly superior QoL at the end of (C)RT, for comparable costs. Overall, when compared to the alternate methods of service-delivery, SwallowIT provided a financially viable and cost-effective method for the delivery of intensive, prophylactic swallowing therapy to patients with HNC during (C)RT.

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Acknowledgements

The authors would like to acknowledge the Princess Alexandra Hospital Study, Education and Research Trust Account (SERTA) and Princess Alexandra Hospital Research Foundation for providing funding to conduct this research. The authors disclose that ATOS Medical (Hörby, Sweden) supplied the Therabite™ ActivBands and subsidised the costs of the Therabite™ devices used in this study. We acknowledge Alison Phelan, Alana Hutchison and the clinical teams at the Metro South Radiation Oncology Service (Brisbane, Australia) for their assistance with data collection, and we thank the participants for their time.

Funding

This study was funded by PA Research Foundation (Grant No. Project Grant), PA Hospital SERTA (Grant No. Small Grant).

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Correspondence to Laurelie R. Wall.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Wall, L.R., Kularatna, S., Ward, E.C. et al. Economic Analysis of a Three-Arm RCT Exploring the Delivery of Intensive, Prophylactic Swallowing Therapy to Patients with Head and Neck Cancer During (Chemo)Radiotherapy. Dysphagia 34, 627–639 (2019). https://doi.org/10.1007/s00455-018-9960-1

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Keywords

  • Deglutition
  • Deglutition disorders
  • Head and neck cancer
  • Telepractice
  • Prophylactic swallowing therapy
  • Cost-effectiveness
  • Economic analysis