Product X increased quality-adjusted life years by 0.0717 and resulted in an incremental net monetary benefit of S$2961, with >99.9% probability of cost-effectiveness at S$45,000/QALY in female early breast cancer patients in Singapore.
Does a novel scalp cooling device (Product X) improve cost-effectiveness and QALYs compared to no scalp cooling in female patients with early breast cancer receiving adjuvant chemotherapy?
A novel, portable scalp cooling device is highly likely to be a cost-effective strategy for preventing chemotherapy-induced alopecia in early breast cancer patients from a health system perspective.
Effect estimate: INMB S$2961 (95% CI 95% UI: S$2906–S$3015)
Absolute Event Rate: 0.0717% vs 0%
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 S265 per patient (95% UI: S251–S281) and incremental quality-adjusted life years (QALY) of 0. 0717 (95% UI: 0. 0705– 0. 0729). At a willingness-to-pay of S45, 000 per QALY, incremental net monetary benefits (INMB) was S2961 (95% UI: S2906–S3015), with > 99. 9% probability of cost-effectiveness. Across all scenarios, INMB ranged from S1158 to S3330. 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. Keywords: scalp cooling, hair loss, breast cancer, chemotherapy side effect, cost-effectiveness
Ouyang et al. (2026) studied Female patients with non-metastatic early breast cancer receiving adjuvant chemotherapy following surgical resection in Singapore tertiary cancer care. Product X (novel cordless portable scalp cooling device) vs. No scalp cooling (current practice) was evaluated on Cost-effectiveness assessed by incremental cost, QALYs, and incremental net monetary benefits (INMB) at willingness-to-pay threshold of S$45,000 per QALY (INMB S$2961, 95% CI 95% UI: S$2906–S$3015). Product X increased quality-adjusted life years by 0.0717 and resulted in an incremental net monetary benefit of S$2961, with >99.9% probability of cost-effectiveness at S$45,000/QALY in female early breast cancer patients in Singapore.