Cost-effectiveness Analysis of Pre- Versus Post-operative Radiotherapy for Patients With Oral Cancer

Background: Treatment for resectable oral cavity cancer (OCC) often includes combinations of surgery and radiotherapy (RT), but there is no conclusive information on by which order these measures are best administered. The aim of this study was to assess cost-effectiveness of two alternative treatment regimens for patients with OCC, reflecting pre-and post-operative RT.Methods: The study was performed on data from the ARTSCAN 2 randomised, controlled trial, which compares pre-operative accelerated RT with post-operative conventionally fractionated RT. Two-hundred-fifty patients were randomised and 240 were eligible for treatment outcomes. Costs were retrieved from the hospital’s economic systems and national registries. The incremental cost-effectiveness ratio (ICER) was calculated, and a sensitivity analysis was performed. Overall survival (OS) was used as effect measure in the analysis.Results: Two-hundred-nine patients completed the treatment and had retrievable data on costs. There was no statistically significant difference in OS between the treatment modalities (log-rank p=0.23). OS at three years was 67% and 74% for pre- and post-operative RT, respectively. Mean direct costs per patient were € 65 958 for pre-operative RT and € 53 172 for post-operative RT, while indirect costs were € 75 874 and € 73 184, respectively. All projected results indicated that post-operative RT was cost-effective in comparison to pre-operative RT.Conclusions: Post-operative RT for patients with resectable OCC is cost-effective compared to pre-operative RT.