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Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland

  • Laryngology
  • Published:
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Abstract

The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore, a model-based cost-effectiveness analysis of using HMEs versus usual care (UC) (including stoma covers, suction system and/or external humidifier) for patients after laryngectomy was performed. Primary outcomes were costs, QALYs and incremental cost-effectiveness ratio (ICER). Secondary outcomes were pulmonary infections, and sleeping problems. The analysis was performed from a health care perspective of Poland, using a time horizon of 10 years and cycle length of 1 year. Transition probabilities were derived from various sources, amongst others a Polish randomized clinical trial. Quality of life data was derived from an Italian study on similar patients. Data on frequencies and mortality-related tracheobronchitis and/or pneumonia were derived from a Europe-wide survey amongst head and neck cancer experts. Substantial differences in quality-adjusted survival between the use of HMEs (3.63 QALYs) versus UC (2.95 QALYs) were observed. Total health care costs/patient were 39,553 PLN (9465 Euro) for the HME strategy and 4889 PLN (1168 Euro) for the UC strategy. HME use resulted in fewer pulmonary infections, and less sleeping problems. We could conclude that given the Polish threshold of 99,000 PLN/QALY, using HMEs is cost-effective compared to UC, resulting in 51,326 PLN/QALY (12,264 Euro/QALY) gained for patients after total laryngectomy. For the hospital period alone (2 weeks), HMEs were cost-saving: less costly and more effective.

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Acknowledgments

We would like to thank gratefully Prof. Ulf Persson, Professor in Health Economics at the Institute of Economic Research, School of Economics and Management, Lund University and Chief Executive Officer at the Swedish Institute for Health Economics (IHE) for reviewing the manuscript.

Conflict of interest

V. P. Retèl is part-time employed at the Clinical Affairs department of Atos Medical AB as a Health Economist. All other authors declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Valesca P. Retèl

  2. Atos Medical AB, P.O. Box 183, 24222, Hörby, Sweden

    Valesca P. Retèl

  3. Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek (NKI-AVL), Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Cindy van den Boer, Frans J. Hilgers & Michiel W. van den Brekel

  4. Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, P.O. Box 19024, Seattle, WA, 98109-1024, USA

    Lotte M. G. Steuten

  5. Department of Otolaryngology and Head and Neck Surgery, Regional Cancer Center, ul. Artwin´skiego 3, 25-734, Kielce, Poland

    Sławomir Okła

  6. Institute of Phonetic Sciences/ACLC, University of Amsterdam, Spuistraat 210, 1012 VT, Amsterdam, The Netherlands

    Frans J. Hilgers & Michiel W. van den Brekel

  7. Department of Oral-Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Michiel W. van den Brekel

Authors
  1. Valesca P. Retèl
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  2. Cindy van den Boer
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  3. Lotte M. G. Steuten
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Correspondence to Valesca P. Retèl.

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Retèl, V.P., van den Boer, C., Steuten, L.M.G. et al. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland. Eur Arch Otorhinolaryngol 272, 2381–2388 (2015). https://doi.org/10.1007/s00405-015-3618-5

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  • DOI: https://doi.org/10.1007/s00405-015-3618-5

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