Valuing Follow-up Programs In Head and Neck Cancer

This thesis deals with the topic of head and neck cancer (HNC) follow-up from a health economics perspective. Despite recent advances in treating primary HNC, the long-term prognosis of these patients is still poor due to a high risk of cancer recurrence. Until now, there is no agreement about the best way of monitoring patients after the end of therapies. Moreover, patients’ preferences for alternative surveillance schemes are unknown. A multicentre randomized controlled trial comparing two follow-up strategies of different intensity is currently ongoing in Italy. This thesis aims at filling some of the literature “gaps” around HNC surveillance, using Italy as a case study. The first chapter introduces the topic. The second chapter is a systematic literature review and critical appraisal of economic evaluation studies of post-treatment follow-up programs in any cancer type. The third chapter is a systematic literature review and quality appraisal of studies reporting original health state utility values in HNC, with a focus on articles addressing the post-treatment phase. The fourth chapter maps the EuroQol 5-Dimension 5-Level (EQ-5D-5L) utility values from two cancer-specific measures developed by the European Organization for Research and Treatment of Cancer (EORTC) by using a variety of regression techniques (linear, Tobit, mixture models) and several EQ-5D-5L country tariff sets; the developed functions are useful to inform future economic evaluations in HNC. The fifth chapter presents an exploratory model-based economic evaluation of the two follow-up strategies under investigation in the trial, where an intensive program of radiological assessments is compared to a symptom-driven surveillance; the cost analysis is conducted from a regional healthcare system perspective in Italy. Lastly, the sixth chapter presents a discrete choice experiment using best-worst scaling to elicit patients’ preferences during follow-up at the National Cancer Institute (Milan, Italy).