{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:47:18Z","timestamp":1792565238272,"version":"4.5.0"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011851","name":"Kom op tegen Kanker","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011851","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head & Neck"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Research on oropharyngeal head and neck cancer (HNC) patients indicates that prophylactic swallowing exercises (PSE) during (C)RT can positively affect muscle strength, swallowing function and quality of life (QOL). Primary analyses of the PRESTO\u2010trial showed higher adherence rates for PSE when exercising daily with a speech\u2010language pathologist (SLP), compared to self\u2010guided exercises with either an exercise diary or a digital application. Additionally, higher adherence rates were related to greater improvements in swallowing function and QOL. However, given limited healthcare resources, cost\u2010effectiveness analyses are essential to inform the implementation of such rehabilitation strategies in dysphagia care. This secondary analysis of the PRESTO\u2010data compares the costs and health effects of the three different service models: app\u2010based, therapist\u2010led (daily face\u2010to\u2010face, 20 sessions during (C)RT), and paper\u2010led therapy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n One hundred fifty patients receiving (chemo)radiotherapy (C)RT for oropharyngeal HNC were randomly assigned to one of the three exercise groups. All performing the same PSE protocol. The treatment protocol required daily training during the first 4\u2009weeks of the (C)RT treatment program. Patients in the therapy group thereby received a total of 20 face\u2010to\u2010face therapy sessions. Health outcomes were expressed as utilities based on the EQ5D5L instrument measured at baseline, post (C)RT and 3\u2009months post (C)RT. Costs were estimated from a health service perspective, including staff time, therapy resources and consumables. Incremental cost\u2010effectiveness ratios (ICERs) were calculated as \u0394Costs\/ \u0394QALYs.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n No significant between\u2010group differences were found for utilities. Only significant time effects were observed, with a significant decrease in utilities from baseline to post (C)RT and a significant increase from post (C)RT to 3\u2009months post (C)RT. The therapist\u2010led intervention was associated with the highest costs. The app\u2010group intervention was dominated by the paper group in terms of cost\u2010effectiveness as the utilities were comparable but at a higher cost in the app\u2010group. Consequently, the ICER was computed between the paper\u2010group and therapist\u2010group and resulted in \u20ac 124\u2009061,54\/QALY.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Despite the overall positive HR\u2010QOL effects post 3\u2009months, the daily therapist\u2010led delivery of PSE therapy was not cost\u2010effective relative to paper\u2010based self\u2010management. Under current resource constraints, low\u2010cost delivery models represent the most economically efficient option. Future research should explore whether hybrid or targeted therapist involvement yields better value by preserving clinical benefit while reducing cost.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/hed.70515","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T06:27:30Z","timestamp":1792564050000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost Effectiveness Analysis of the Presto\u2010Trial: A Three\u2010Armed\n RCT<\/scp>\n Evaluating Prophylactic Swallowing Exercises in Head and Neck Cancer Patients During (Chemo)radio Treatment"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0173-5804","authenticated-orcid":false,"given":"Alice","family":"Vergauwen","sequence":"first","affiliation":[{"name":"Department of Translational Neurosciences University of Antwerp Antwerp Belgium"},{"name":"Department of Human Structure and Repair Ghent University Ghent Belgium"},{"name":"Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Center for Communication Disorders Antwerp University Hospital Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leen","family":"Van den Steen","sequence":"additional","affiliation":[{"name":"Department of Translational Neurosciences University of Antwerp Antwerp Belgium"},{"name":"Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Center for Communication Disorders Antwerp University Hospital Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0431-5854","authenticated-orcid":false,"given":"Margot","family":"Baudelet","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Ghent Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3192-181X","authenticated-orcid":false,"given":"Ann","family":"Goeleven","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Research Group Experimental Oto\u2010Rhino\u2010Laryngology \u2013 Deglutology KU Leuven Leuven Belgium"},{"name":"Department of Head and Neck Surgery, Swallowing Clinic University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5540-4796","authenticated-orcid":false,"given":"Sandra","family":"Nuyts","sequence":"additional","affiliation":[{"name":"Department of Oncology, Leuven Cancer Institute University Hospitals Leuven Belgium"},{"name":"Department of Oncology, Laboratory of Experimental Radiotherapy KU Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daan","family":"Nevens","sequence":"additional","affiliation":[{"name":"Department of Translational Neurosciences University of Antwerp Antwerp Belgium"},{"name":"Department of Radiotherapy AZ Groeninge Kortrijk Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6331-9738","authenticated-orcid":false,"given":"Hanne","family":"Massonet","sequence":"additional","affiliation":[{"name":"Department of Translational Neurosciences University of Antwerp Antwerp Belgium"},{"name":"Department of Neurosciences, Research Group Experimental Oto\u2010Rhino\u2010Laryngology \u2013 Deglutology KU Leuven Leuven Belgium"},{"name":"Department of Head and Neck Surgery, Swallowing Clinic University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7633-1960","authenticated-orcid":false,"given":"Fr\u00e9deric","family":"Duprez","sequence":"additional","affiliation":[{"name":"Department of Human Structure and Repair Ghent University Ghent Belgium"},{"name":"Department of Radiation Oncology Ghent University Hospital Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6934-4168","authenticated-orcid":false,"given":"Gwen","family":"Van Nuffelen","sequence":"additional","affiliation":[{"name":"Department of Translational Neurosciences University of Antwerp Antwerp Belgium"},{"name":"Department of Human Structure and Repair Ghent University Ghent Belgium"},{"name":"Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Center for Communication Disorders Antwerp University Hospital Antwerp Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"The World Health Report: Health Systems Financing: The Path to Universal Coverage","author":"Evans D. 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