Cost-Effectiveness of Reduced Waiting Time for Head and Neck Cancer Patients due to a Lean Process Redesign

P.A.M. Simons*, B. Ramaekers, F. Hoebers, K.W. Kross, W. Marneffe, M. Pijls-Johannesma, D. Vandijck

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Compared with new technologies, the redesign of care processes is generally considered less attractive to improve patient outcomes. Nevertheless, it might result in better patient outcomes, without further increasing costs. Because early initiation of treatment is of vital importance for patients with head and neck cancer (HNC), these care processes were redesigned. Objectives: This study aimed to assess patient outcomes and cost-effectiveness of this redesign. Methods: An economic (Markov) model was constructed to evaluate the biopsy process of suspicious lesion under local instead of general anesthesia, and combining computed tomography and positron emission tomography for diagnostics and radiotherapy planning. Patients treated for HNC were included in the model stratified by disease location (larynx, oropharynx, hypopharynx, and oral cavity) and stage (I-II and 111-IV). Probabilistic sensitivity analyses were performed. Results: Waiting time before treatment start reduced from 5 to 22 days for the included patient groups, resulting in 0.13 to 0.66 additional quality-adjusted life-years. The new workflow was cost-effective for all the included patient groups, using a ceiling ratio of (sic)80,000 or (sic)20,000. For patients treated for tumors located at the larynx and oral cavity, the new workflow resulted in additional quality-adjusted life-years, and costs decreased compared with the regular workflow. The health care payer benefited (sic)14.1 million and (sic)91.5 million, respectively, when individual net monetary benefits were extrapolated to an organizational level and a national level. Conclusions: The redesigned care process reduced the waiting time for the treatment of patients with HNC and proved cost-effective. Because care improved, implementation on a wider scale should be considered. Copyright (C) 2015, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Original languageEnglish
Pages (from-to)587-596
Number of pages10
JournalValue in Health
Issue number5
Publication statusPublished - Jul 2015


  • cost-effectiveness analysis
  • economic evaluation
  • head and neck
  • process redesign
  • waiting time
  • CARE

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