Scalp cooling and chemotherapy-induced alopecia: Evaluating cost-effectiveness and insurance coverage

Chemotherapy-induced alopecia (CIA) substantially affects patients' quality of life. Scalp cooling, or cold capping, reduces chemotherapy uptake in hair follicles and can help preserve hair, but insurance coverage remains inconsistent, limiting access. We conducted a cost-effectiveness analysis from a payer perspective comparing scalp cooling with 2 dermatologic management strategies for CIA. The incremental cost-effectiveness ratio (ICER) for scalp cooling was $3,050 per QALY versus dermatologic management plus minoxidil and -$2,950 per QALY versus dermatologic management plus minoxidil and platelet-rich plasma. Both ICERs fall below common United States willingness-to-pay thresholds, indicating that scalp cooling is cost-effective. These findings suggest that scalp cooling is a financially reasonable supportive care intervention and should be considered for routine insurance coverage.