Economic evaluation of automated scalp cooling systems for breast cancer patients in Spain

Different alternatives exist to prevent chemotherapy-induced alopecia (CIA), such as scalp cooling (SC). We conducted an economic evaluation to assess SC systems for breast cancer patients in Spain. A decision tree was built to compare automated SC systems (DigniCap® and Paxman) with the usual clinical practice in Spain (not using the SC), over an 18-month time horizon and applying the National Health Service (NHS) and social perspectives. The target population were women diagnosed with breast cancer (stages I and II), undergoing chemotherapy treatment. We estimated the number of women preventing CIA, quality-adjusted life years (QALYs), incremental costs, and the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The DigniCap® system increased costs by €505.97 and €251.8 (NHS and social perspectives), while the Paxman system did by €176.95 (NHS perspective), compared to not using SC. Both systems could generate 0.03 QALYs more than the usual clinical practice. The ICERs were below the willingness to pay threshold (€25 000 per QALY). Paxman, from the social perspective, represented a cost reduction of €77.22, being less costly and more effective in terms of QALYs. Sensitivity analyses confirmed these results. SC systems prevented CIA in 47% of the target population. Automated SC systems could generate a higher cost (except Paxman from the social perspective) and more QALYs compared to the usual clinical practice in Spain. They could be considered cost-effectiveness technologies or a dominant alternative, in the case of Paxman applying a social perspective.