Authors' objectives: HTW identified and summarised evidence for the following question: What is the clinical and cost effectiveness of photobiomodulation to prevent or treat oral mucositis in people receiving cancer treatment?

Authors' results and conclusions: One systematic review and meta-analysis was identified that included 29 randomised controlled trials (RCTs) comparing photobiomodulation with either control, sham or standard care. HTW also identified 6 additional RCTs that were published after the systematic review was undertaken, and one RCT follow-up. Most studies evaluated laser photobiomodulation; one RCT compared light-emitting diode (LED) photobiomodulation with sham control. Overall, evidence showed that preventative laser photobiomodulation can reduce the risk of severe oral mucositis, reduce the overall mean grade of oral mucositis, and reduce pain (as measured using a visual analogue scale). Using laser photobiomodulation to treat existing cases of oral mucositis did not reduce the remission rates of severe oral mucositis (measured by the number of patients who still had severe oral mucositis after seven days of treatment), but it did reduce the overall duration of having severe oral mucositis. No health economic studies were included due to the available evidence being undertaken in a non-comparable non-OECD country. We developed a cost utility analysis, from the Welsh NHS perspective, which compared the delivery of laser photobiomodulation as a preventative intervention compared to standard care. Costs were driven by high staffing time requirements. Laser photobiomodulation was assessed as being clinically beneficial and cost incurring. The resulting incremental cost effectiveness ratio (ICER) per quality-adjusted life-year (QALY) was £33,334. This is above the commonly accepted threshold of £20,000 per QALY, indicating that the intervention is not cost effective. LED photobiomodulation was assessed as being a cheaper option to deliver compared to laser photobiomodulation due to the shorter session duration and ease of delivery. In the absence of sufficient clinical evidence, no conclusions were arrived at for LED photobiomodulation.

Authors' recommendations: One systematic review and meta-analysis was identified that included 29 randomised controlled trials (RCTs) comparing photobiomodulation with either control, sham or standard care. HTW also identified 6 additional RCTs that were published after the systematic review was undertaken, and one RCT follow-up. Most studies evaluated laser photobiomodulation; one RCT compared light-emitting diode (LED) photobiomodulation with sham control. Overall, evidence showed that preventative laser photobiomodulation can reduce the risk of severe oral mucositis, reduce the overall mean grade of oral mucositis, and reduce pain (as measured using a visual analogue scale). Using laser photobiomodulation to treat existing cases of oral mucositis did not reduce the remission rates of severe oral mucositis (measured by the number of patients who still had severe oral mucositis after seven days of treatment), but it did reduce the overall duration of having severe oral mucositis. No health economic studies were included due to the available evidence being undertaken in a non-comparable non-OECD country. We developed a cost utility analysis, from the Welsh NHS perspective, which compared the delivery of laser photobiomodulation as a preventative intervention compared to standard care. Costs were driven by high staffing time requirements. Laser photobiomodulation was assessed as being clinically beneficial and cost incurring. The resulting incremental cost effectiveness ratio (ICER) per quality-adjusted life-year (QALY) was £33,334. This is above the commonly accepted threshold of £20,000 per QALY, indicating that the intervention is not cost effective. LED photobiomodulation was assessed as being a cheaper option to deliver compared to laser photobiomodulation due to the shorter session duration and ease of delivery. In the absence of sufficient clinical evidence, no conclusions were arrived at for LED photobiomodulation.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

URL for project: https://healthtechnology.wales/reports-guidance/photobiomodulation/

Year Published: 2022

URL for published report: https://healthtechnology.wales/reports-guidance/photobiomodulation/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk