Cost-Effectiveness Analysis on New Generation Heat and Moisture Exchangers for Laryngectomized Patients in Japan

OBJECTIVES: Total laryngectomy (TL) surgery represents the last surgical treatment option for patients with laryngeal cancer, however, it is often accompanied by significant post-operative issues. The use of heat and moisture exchangers (HMEs) by patients who undergo TL reduces pulmonary problems. We investigated whether the new generation HMEs and adhesives (Provox Life) are cost-effective compared to the current HMEs and adhesives for laryngectomized patients in Japan.

METHODS: A Markov model with five health states was adapted to calculate the difference in health outcomes (i.e., pulmonary infections, mucus plug events, skin irritation and quality adjusted life year (QALYs), over 10 years. This study used the Cough and Sputum Assessment Questionnaire (CASA-Q) to identify health states that distinguish in health-related Quality of Life. The existing Portuguese model was adapted for Japan based on focused literature search for Japan specific parameters and validation by clinical and health economics experts. The analytical perspective was that of the Japanese healthcare payer.

RESULTS: Based on the available evidence, the model-based analysis showed that Provox Life improves the effect (QALY) (+0.3759) and increases the total healthcare spending per patient over 10 years compared to the current HMEs for laryngectomized patients in Japan. As a result of the cost-effectiveness analysis, the ICER was less than ¥5,000,000, the threshold value commonly used in Japan including for medical devices. TL is considered a rare condition, and in Japan, a higher threshold value is applied once considering factors such as rare disease, pediatrics, and oncology. The analysis also showed that the use of Provox Life decreases the number of pulmonary infections, mucus plug events, and skin irritation compared with the use of existing HMEs.

CONCLUSIONS: This analysis indicated that the introduction of a new generation HMEs among TL patients in Japan is more cost-effective than the existing HMEs.