Análise de custo-efetividade da frequência de irradiação a laser na prevenção da mucosite oral secundária à Terapia Antineoplásica em pacientes com câncer de cabeça e pescoço

Abstract

The study aimed to conduct a comprehensive cost-effectiveness analysis of FBM protocols administered twice, three times, and five times a week, compared to no prevention, for the prevention of severe oral mucositis (SOM) in patients with head and neck cancer (HNC), from the perspective of the Brazilian Unified Health System (SUS). SOM was defined as grades 3 and 4 according to the World Health Organization. A decision tree model with a one-year time horizon was used, considering the scenario of a public referral hospital, in which a qualified professional performs therapeutic laser therapy only twice a week, with no routine prevention services available. Direct costs were obtained through micro-costing, including the cost of equipment, qualified personnel, and biosafety materials. Effectiveness was defined as the proportion of patients without MOG, using data extracted from the literature on clinical trials. The analyses included the Incremental Cost-Effectiveness Ratio (ICER), Net Monetary Benefit (NMB), and probabilistic sensitivity analysis via Monte Carlo simulation. The electronic search conducted between March and April 2025 retrieved 2,545 studies from the PubMed, Scopus, Scielo, and Web of Science databases, in addition to 96 studies retrieved from the gray literature. After removing duplicates, reviewing titles and abstracts, and reading the full texts, 9 studies were selected to comprise the analysis data. All studies showed a low risk of bias following analysis using the RoB2 and ROBINS-I tools. The results demonstrated that the twice-weekly frequency had a cost of R$8,226.90 with an effectiveness of 0.86, making it the most cost-effective strategy, with an IRR of 647.56, meaning that an increase in effectiveness of 55% cost 647.56 reais, representing an average cost of 6.50 reais per 1% gain in effectiveness, and yielding the highest net monetary benefit and approximately a 73% gain compared to no prevention; however, it had less evidence. The three-times-a-week (cost of R$ 16,102.53 and effectiveness of 0.77) and five-times-a-week (cost of R$ 24,243.39 and effectiveness of 0.78) protocols were ruled out because they had higher costs without additional gains in effectiveness. The cost related to professional labor was the main component of total costs. It was concluded that MOG prevention with laser FBM has a better cost-effectiveness ratio compared to non-prevention, with a twice-weekly frequency being the most cost-effective alternative for MOG prevention in patients with head and neck cancer in the context studied.