Evaluating the cost-effectiveness of low-level laser therapy (LLLT) in head and neck cancer patients submitted to concurrent chemoradiation.

Abstract

6071 Background: Oralmucositis (OM) is a main factor for increasing treatment costs in head and neck squamous cell carcinoma (HNSCC) patients (pts) treated with chemoradiation (CRT). This study was designed to estimate the cost-effectiveness of LLLT to prevent oral mucositis in HNSCC patients submitted to CRT. Methods: From June 2007 to Dec 2010, 94 patients with HNSCC of nasopharynx, oropharynx and hypopharynx entered a prospective, randomized, double blind, placebo-controlled, phase III trial (47 LLLT (LG) and 47 placebo (PG)). CRT consisted of conventional RT 70.2 Gy (1.8Gy/d, 5 times/wk) + concurrent cisplatin 100 mg/m2 every 3 wks. The LLLT used daily was a diode InGaAlP (660nm-100mW-4J/cm²). OM evaluation was done by WHO and OMAS scale. The resources used by patients in both groups were documented during the trial. Unit costs for procedures were obtained from a public reference list (SIGTAP / SUS) as of Jan 2012 and unit costs for drugs were based on ex-factory prices. The cost per laser session was US$ 34.00 (exchange rate from Brazilian currency to US dollar = 1.95) for the baseline analysis. Costs of RT, chemotherapy, fluconazole and chlorhexidine 0.12% were equivalent in both groups and therefore not included in the analysis. Hospitalization rates associated with the treatment of oropharyngeal or oral mucositis were not documented in the study and were estimated according to previously published data. Results: Under the perspective of the Brazilian public healthcare system (SUS), total costs were higher in PG than LG on opioide use (LG= US$ 29.45; PG= US$143.72, gastrostomy (LG= US$ 41.69; PG= US$107.22 ) and hospitalization (PG= US$ 63.59). In LG costs were higher with laser therapy (US$ 1,549.50). The total incremental cost associated with the use of LLLT was US$ 1,306.61 per patient. The incremental cost-effectiveness ratio (ICER) was US$ 3,838.16 per case of grade 3 and 4 mucositis avoided when compared with no treatment. Conclusions: Our results indicate that laser group had a smaller morbidity during treatment and LLLT is cost-effective when compared to pacebo under a threshold of at least US$ 4,000 per avoided mucositis case. Clinical trial information: NCT01439724.

Tratamento da mucosite oral com laser de baixa potência: revisão sistemática de literatura

“…A presença de mucosite oral além de aumentar as chances de infecção dos pacientes internados colabora para o aumento de custo do tratamento oncológico 8,18,19 . A terapia com laser de baixa potência pode ser acompanhada de outros tratamentos de suporte para mucosite oral, como analgésicos, anti-inflamatório não esteroidais ou opioides, além da aplicação de anestésico gel oral e agente citoprotetor (hidróxido de alumínio e magnésio), sendo que esse suporte não interfere nos efeitos de cicatrização e analgesia do lazer de baixa potência 6,10 .…”

“…O melhor parâmetro ao tratamento associado à radioterapia em regiões de cabeça e pescoço precisa ser estabelecido, porque a máxima densidade de energia estudada de 6,0 J/cm² está relacionada apenas à quimioterapia 4,5,[21][22][23] . A radioterapia em região de cabeça e pescoço na densidade de energia de 4,0 J/cm² ainda relata acometimento de mucosite oral nos graus 3 e 4 2,18,19 . O tratamento com laser de baixa potência deve ser incentivado em ambiente hospitalar pela redução dos sintomas de dor e graus de acometimento da mucosite oral nos pacientes em tratamento oncológico 5,6,18,19,[23][24][25] .…”

“…A radioterapia em região de cabeça e pescoço na densidade de energia de 4,0 J/cm² ainda relata acometimento de mucosite oral nos graus 3 e 4 2,18,19 . O tratamento com laser de baixa potência deve ser incentivado em ambiente hospitalar pela redução dos sintomas de dor e graus de acometimento da mucosite oral nos pacientes em tratamento oncológico 5,6,18,19,[23][24][25] .…”