The Early Cost-Effectiveness of a Novel Scalp Cooling Device to Alleviate Chemotherapy-Induced Alopecia in Patients with Early Breast Cancer.

BACKGROUND

Chemotherapy-induced alopecia is a common side effect with psychological impacts that affect quality of life. Up to 14% of patients may decline chemotherapy due to concerns over hair loss. While existing scalp cooling therapies can reduce alopecia, constraints including space, staffing, and extended chair time limit their use in health services. Hence, a novel scalp cooling cap ("Product X") was developed to address this gap. Product X is cordless and portable and does not require patients to remain in treatment chairs post-chemotherapy. This early-stage cost-effectiveness analysis addresses the potential economic value of adopting Product X versus current practice (no scalp cooling).

METHODS

We developed a decision tree and a lifetime Markov model to estimate change to total costs and health benefits for female patients with early breast cancer, from a health system perspective in a Singapore tertiary cancer care setting. The model incorporated costs related to scalp cooling equipment and administration, chemotherapy, and treatment for cancer recurrence. Assumptions regarding Product X's efficacy and its potential impact on chemotherapy compliance were tested in nine scenario analyses (efficacy: 50%, 75%, 100%; compliance improvement: 0, 1%, 5%). Probabilistic scenario analysis was conducted using Monte Carlo simulation with 1000 iterations from appropriate parameter distributions.

RESULTS

In the base case (1% improvement in compliance and 100% efficacy), Product X yielded an incremental cost of S$265 per patient (95% UI: S$251-S$281) and incremental quality-adjusted life years (QALY) of 0.0717 (95% UI: 0.0705-0.0729). At a willingness-to-pay of S$45,000 per QALY, incremental net monetary benefits (INMB) was S$2961 (95% UI: S$2906-S$3015), with >99.9% probability of cost-effectiveness. Across all scenarios, INMB ranged from S$1158 to S$3330.

CONCLUSION

Scenario and probabilistic analyses suggest that Product X is a cost-effective solution for chemotherapy-induced alopecia, supporting its adoption from a health system perspective.