Cost-utility and cost-effectiveness of a guided self-help head and neck exercise program for patients treated with total laryngectomy: Results of a multi-center randomized controlled trial: Results of a multi-center randomized controlled trial

Femke Jansen, Veerle M. H. Coupé, Simone E. J. Eerenstein, Ingrid C. Cnossen, Cornelia F. van Uden-Kraan, Remco de Bree, Patricia Doornaert, György B. Halmos, José A. U. Hardillo, Gerben van Hinte, Jimmie Honings, C. René Leemans, Irma M. Verdonck-de Leeuw

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Objectives: The guided self-help exercise program called In Tune without Cords (ITwC) is effective in improving swallowing problems and communication among patients treated with a total laryngectomy (TL). This study investigated the cost-utility and cost-effectiveness of ITwC. Materials and methods: Patients within 5 years after TL were included in this randomized controlled trial. Patients in the intervention group (n = 46) received access to the self-help exercise program with flexibility, range-of-motion and lymphedema exercises, and a self-care education program. Patients in the control group (n = 46) received access to the self-care education program only. Healthcare utilization (iMCQ), productivity losses (iPCQ), health status (EQ-5D-3L, EORTC QLU-C10D) and swallowing problems (SwalQol) were measured at baseline, 3- and 6-months follow-up. Hospital costs were extracted from medical files. Mean total costs and effects (quality-adjusted life-years (QALYs) or SwalQol score) were compared with regression analyses using bias-corrected accelerated bootstrapping. Results: Mean total costs were non-significantly lower (-€685) and QALYs were significantly higher (+0.06) in the intervention compared to the control group. The probability that the intervention is less costly and more effective was 73%. Sensitivity analyses with adjustment for baseline costs and EQ-5D scores showed non-significantly higher costs (+€119 to +€364) and QALYs (+0.02 to +0.03). A sensitivity analysis using the QLU-C10D to calculate QALYs showed higher costs (+€741) and lower QALYs (-0.01) and an analysis that used the SwalQol showed higher costs (+€232) and higher effects (improvement of 6 points on a 0–100 scale). Conclusion: ITwC is likely to be effective, but possibly at higher expenses. Trial Registration: NTR5255.
Original languageEnglish
Article number105306
JournalOral Oncology
Publication statusPublished - 1 Jun 2021


  • Cost-effectiveness
  • Cost-utility
  • Economic evaluation
  • Exercise program
  • Head and neck cancer
  • Shoulder problems
  • Speech problems
  • Swallowing problems
  • Total laryngectomy

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