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Trakimas DR, Mydlarz W, Mady LJ, Koch W, Quon H, London NR, Fakhry C. Increasing radiation therapy and lower survival for human papillomavirus-related oropharynx cancer associated with a shift to community cancer center care. J Natl Cancer Inst 2024; 116:1051-1062. [PMID: 38167712 PMCID: PMC11223870 DOI: 10.1093/jnci/djad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/20/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Studies have shown lower overall survival for patients with head and neck cancer treated at low-volume or community cancer centers. As the incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma steadily rises in the United States, we hypothesized that a greater proportion of patients with HPV-related oropharyngeal squamous cell carcinoma is being treated at community cancer centers, with a shift toward primary nonsurgical treatment. METHODS This cohort study included patients from the US National Cancer Database who received a diagnosis of HPV-related oropharyngeal squamous cell carcinoma from 2010 to 2019 and underwent treatment at a community cancer center or academic cancer center. The proportion of patients with HPV-related oropharyngeal squamous cell carcinoma treated at community cancer centers and receiving primary nonsurgical treatment was analyzed over time. Four-year overall survival was compared between community cancer centers and academic cancer centers. RESULTS The majority (67.4%) of 20 298 patients were treated at an academic cancer center, yet the proportion of patients treated at community cancer centers increased by 10% from 2010 to 2019 (P < .01 for trend). The proportion of patients undergoing primary nonsurgical treatment increased from 62.1% to 73.7% from 2010 to 2019 (P < .01 for trend), and patients were statistically significantly more likely to undergo nonsurgical treatment at community cancer centers than at academic cancer centers (adjusted odds ratio = 1.20, 95% confidence interval = 1.18 to 1.22). Treatment at community cancer centers was associated with worse survival overall (adjusted hazard ratio = 1.19, 95% confidence interval = 1.09 to 1.31), specifically for patients receiving primary nonsurgical treatment (adjusted hazard ratio = 1.22, 95% confidence interval = 1.11 to 1.34). CONCLUSIONS Treatment of HPV-related oropharyngeal squamous cell carcinoma has recently shifted to community cancer centers, with an increase in the proportion of nonsurgical treatment and worse overall survival at these centers compared with academic cancer centers. Concentration of care for HPV-related oropharyngeal squamous cell carcinoma at academic cancer centers and dedicated head and neck cancer centers may increase access to all available treatment modalities and improve survival.
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Affiliation(s)
- Danielle R Trakimas
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wojtek Mydlarz
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Leila J Mady
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wayne Koch
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Harry Quon
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nyall R London
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
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Dong C, Fu JT, Wu HR, Chao YC, Chen YC, Sung WW, Chen WJ, Chen CJ. Mortality-to-Incidence Ratio for Nasopharyngeal Carcinoma Is Associated with Health Expenditure. Healthcare (Basel) 2022; 10:healthcare10091615. [PMID: 36141227 PMCID: PMC9498620 DOI: 10.3390/healthcare10091615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/13/2022] [Accepted: 08/19/2022] [Indexed: 12/24/2022] Open
Abstract
Geographic and gender-specific disparity can be observed in nasopharyngeal carcinoma (NPC). While screening and more effective therapies, such as induction chemotherapy, could improve survival rates, they are costly. This study aims to explore the correlation between healthcare expenditure and the mortality-to-incidence ratio (MIR) in NPC. Data were obtained from the World Health Organization and the Global Cancer Observatory. The correlation was evaluated by Spearman’s rank correlation coefficient. Most new cases and deaths occur in Asia, and more males are affected than females. Our study shows that countries with higher MIRs have lower levels of health expenditure regardless of the NPC’s gender-specific incidence. Correspondingly, MIRs are all significantly negatively associated with current health expenditure (CHE) per capita and CHE as a percentage of gross domestic product (CHE/GDP) in both genders. CHE per capita and CHE/GDP have a significant impact on NPC outcomes. Moreover, economic status is a potential major factor in MIR differences between countries.
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Affiliation(s)
- Chen Dong
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Jing-Tong Fu
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40201, Taiwan
| | - Han-Ru Wu
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Chi Chao
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Ying-Ching Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Wen-Wei Sung
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Wen-Jung Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Correspondence: (W.-J.C.); (C.-J.C.); Tel.: +886-4-24739595 (ext. 34803) (W.-J.C.); +886-4-2359-2525 (C.-J.C.)
| | - Chih-Jung Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40201, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Correspondence: (W.-J.C.); (C.-J.C.); Tel.: +886-4-24739595 (ext. 34803) (W.-J.C.); +886-4-2359-2525 (C.-J.C.)
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Fokom Domgue J, Yu RK, Shete S. Trends in the rates of health-care providers' recommendation for HPV vaccine from 2012 to 2018: a multi-round cross-sectional analysis of the health information national trends survey. Hum Vaccin Immunother 2021; 17:3081-3089. [PMID: 34085904 PMCID: PMC8381778 DOI: 10.1080/21645515.2021.1917235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/06/2021] [Indexed: 12/31/2022] Open
Abstract
The 2012 report of the President's Cancer Panel highlighted the overriding contribution of missed clinical opportunities to suboptimal HPV vaccination coverage. Since then, it remains unknown whether the rates of provider recommendations for the HPV vaccine in the US population have increased. We conducted an analysis of four rounds of the Health Information National Trends Survey (HINTS), a household survey of civilian US residents aged 18 y or older. A total of 1,415 (2012), 1,476 (2014), 1,208 (2017), and 1,344 (2018) respondents to the HINTS survey who were either HPV vaccine-eligible or living with HPV vaccine-eligible individuals were included. Overall, the rates of providers' recommendations remained stagnated from 2012 to 2018 in all categories of the study population, except for non-Hispanic Blacks (NHBs), where this prevalence increased during the study period (AAPC = 16.4%, p < .001). In vaccine-eligible individuals (18-27 y), declining trends were noted overall (AAPC = -21.6%, p < .001), among NHWs (AAPC = -30.2%, p < .001) and urban dwellers (AAPC = -21.4%, p < .001). Among vaccine-ineligible respondents (˃27 y) living with vaccine-eligible individuals, trends in the prevalence of provider recommendations for HPV vaccine were stagnating overall (AAPC = 0.5%, p = .90), and increasing only among NHBs (AAPC = 13.9%, p < .001). Despite recent progress, our findings indicate variations of trends in provider recommendations for the HPV vaccine in the US adult population according to age, sex, race/ethnicity, and residence. To accelerate HPV vaccination uptake, immediate actions to enhance provider recommendation for HPV vaccine are needed.
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Affiliation(s)
- Joël Fokom Domgue
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert K. Yu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Jurica JM, Rubio F, Hernandez DJ, Sandulache VC. Institutional financial toxicity of failure to adhere to treatment guidelines for head and neck squamous cell carcinoma. Head Neck 2020; 43:816-824. [PMID: 33166016 DOI: 10.1002/hed.26539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/04/2020] [Accepted: 10/29/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Delays in treatment of head and neck squamous cell carcinoma (HNSCC) are known to increase disease recurrence, generating the need for additional salvage treatment, often with immunotherapy. METHODS Three treatment metrics were identified: time from diagnosis to treatment initiation (TTI), time from surgery to postoperative radiotherapy (surg → PORT), and total treatment package time (TPT). Financial toxicity was calculated using hazard ratios, pembrolizumab cost, and dosing data for a Veterans Health Administration (VHA) institutional cohort (n = 338) and a standardized cohort (n = 100). RESULTS Estimated financial toxicity for the VHA cohort was $2 047 407, $316 545, and $1 114 101 for TTI, surg → PORT, and TPT, respectively. Estimated financial toxicity for the standardized patient cohort was $454 028, $544 576, and $1 879 628 for TTI, surg → PORT, and TPT, respectively. CONCLUSIONS Failure to meet established HNSCC treatment metrics generates significant, yet avoidable, institutional financial toxicity which is particularly relevant to integrated single-payer systems such as the VHA in the modern immunotherapy era.
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Affiliation(s)
- James M Jurica
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Felixnando Rubio
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David J Hernandez
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Vlad C Sandulache
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Bitterman DS, Cagney DN, Singer LL, Nguyen PL, Catalano PJ, Mak RH. Master Protocol Trial Design for Efficient and Rational Evaluation of Novel Therapeutic Oncology Devices. J Natl Cancer Inst 2020; 112:229-237. [PMID: 31504680 PMCID: PMC7073911 DOI: 10.1093/jnci/djz167] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022] Open
Abstract
Historically, the gold standard for evaluation of cancer therapeutics, including medical devices, has been the randomized clinical trial. Although high-quality clinical data are essential for safe and judicious use of therapeutic oncology devices, class II devices require only preclinical data for US Food and Drug Administration approval and are often not rigorously evaluated prior to widespread uptake. Herein, we review master protocol design in medical oncology and its application to therapeutic oncology devices, using examples from radiation oncology. Unique challenges of clinical testing of radiation oncology devices (RODs) include patient and treatment heterogeneity, lack of funding for trials by industry and health-care payers, and operator dependence. To address these challenges, we propose the use of master protocols to optimize regulatory, financial, administrative, quality assurance, and statistical efficiency of trials evaluating RODs. These device-specific master protocols can be extrapolated to other devices and encompass multiple substudies with the same design, statistical considerations, logistics, and infrastructure. As a practical example, we outline our phase I and II master protocol trial of stereotactic magnetic resonance imaging–guided adaptive radiotherapy, which to the best of our knowledge is the first master protocol trial to test a ROD. Development of more efficient clinical trials is needed to promote thorough evaluation of therapeutic oncology devices, including RODs, in a resource-limited environment, allowing more practical and rapid identification of the most valuable advances in our field.
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Affiliation(s)
- Danielle S Bitterman
- Harvard Radiation Oncology Program, Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Daniel N Cagney
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lisa L Singer
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul J Catalano
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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6
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Assessing the Financial Toxicity of Radiation Oncology Patients Using the Validated Comprehensive Score for Financial Toxicity as a Patient-Reported Outcome. Pract Radiat Oncol 2020; 10:e322-e329. [DOI: 10.1016/j.prro.2019.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/05/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023]
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Wu CF, Lairson DR, Dahlstrom KR, Fokom Domgue J, Fu S, Sturgis EM, Chan W. Lifetime health care costs of oropharyngeal cancer for commercially insured patients in the United States. Head Neck 2020; 42:2321-2329. [PMID: 32359131 DOI: 10.1002/hed.26201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/09/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Incidence of oropharyngeal cancer (OPC) is expected to increase but its health care cost is unknown. The purpose for this study was to estimate the phase-specific lifetime health care costs of OPC for commercially insured individuals in the United States. METHODS We used the Truven MarketScan Commercial Claims and Encounter Database to identify our patient population. Cox survival analysis was used to estimate patients' monthly survival probabilities. We determined the ratios of the cumulative costs up to a particular survival probability and the costs from that time point to death for all subjects who died before end of the 5-year follow-up period. This relationship was then used to predict phase-specific lifetime health care costs. RESULTS Our study included 2445 patients with OPC. The predicted phase-specific lifetime health care costs attributable to OPC were $88 872, $24 038, and $1537 in the initial, continuous, and terminal phases, respectively, among commercially insured patients.
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Affiliation(s)
- Chi-Fang Wu
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Joël Fokom Domgue
- Department of Epidemiology and Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Cameroon
| | - Shuangshuang Fu
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Comparative cost of transoral robotic surgery and radiotherapy (IMRT) in early stage tonsil cancer. Am J Otolaryngol 2020; 41:102409. [PMID: 32057489 DOI: 10.1016/j.amjoto.2020.102409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare treatment costs and cost-effectiveness for transoral robotic surgery (TORS) and definitive intensity-modulated radiotherapy (IMRT) in managing early stage tonsil cancer. MATERIALS AND METHODS Direct treatment costs for surgery and IMRT were calculated from SEER-Medicare data for a cohort with clinically early stage (cT1/2N0) p16+ tonsillar squamous cell carcinoma from Kaiser Permanente Southern California Health Plan between 2012 and 2017. A Markov decision tree model with a 5-year time horizon was then applied to the cohort which incorporated costs associated with treatment, surveillance, and recurrence. RESULTS IMRT cost up to $19,000 more (35%) than TORS in direct treatment costs. When input into the Markov model, TORS dominated IMRT with lower cost and better effectiveness over a range of values. CONCLUSION TORS is a more cost-effective treatment method than IMRT in early stage (cT1/2N0) tonsil cancer.
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Direct medical cost of oropharyngeal cancer among patients insured by Medicaid in Texas. Oral Oncol 2019; 96:21-26. [PMID: 31422209 DOI: 10.1016/j.oraloncology.2019.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/17/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the direct 2-year mean incremental medical care costs for incident oropharyngeal cancer (OPC) from the perspective of the Texas Medicaid program. METHODS OPC patients treated from 2008 to 2012 were selected in the Texas Medicaid database. Using a two-step 1:1 propensity score matching method, we selected controls to determine the differential cost associated with OPC. Monthly and yearly direct costs were estimated for 2 years after the cancer diagnosis. For patients without 2-year complete follow-up, a generalized linear model with gamma distribution and log link function was applied to predict costs for the censored months. RESULTS A total of 352 patients with OPC and the same number of controls were included in the study. Among OPC patients, 204 (58%) were covered by Medicaid and Medicare, and 148 patients (42%) were insured under Medicaid only. The adjusted first- and second-year mean differential costs were $45,102 and $11,684 for Medicaid-only enrollees and $5734 and $2162 for Medicaid-Medicare dual-eligible enrollees, respectively. Being male, Hispanic, Medicaid-only eligible, living in the Harlingen region, and having more comorbidities were positively associated with monthly cost. Lubbock residents experienced lower costs. CONCLUSIONS The direct incremental medical costs associated with OPCs among patients insured by Texas Medicaid were substantial in the first 2 years after cancer diagnosis and should be considered in assessing the economic consequences of increasing the investment in HPV vaccination in Texas.
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Chesson HW, Meites E, Ekwueme DU, Saraiya M, Markowitz LE. Updated medical care cost estimates for HPV-associated cancers: implications for cost-effectiveness analyses of HPV vaccination in the United States. Hum Vaccin Immunother 2019; 15:1942-1948. [PMID: 31107640 DOI: 10.1080/21645515.2019.1603562] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Estimates of medical care costs for cervical and other cancers associated with human papillomavirus (HPV) are higher in studies published in recent years than in studies published before 2012. The purpose of this report is (1) to review and summarize the recent cancer cost estimates and (2) to illustrate how the estimated cost-effectiveness of HPV vaccination might change when these recent cost estimates are applied. Our literature search yielded 6 studies that provided updated medical care cost estimates for 5 HPV-associated cancers. We found that applying the current cancer cost estimates had a notable impact on the estimated medical costs averted by HPV vaccination over an extended time frame (100 years), and a moderate impact on the estimated cost per quality-adjusted life year (QALY) gained by HPV vaccination. For example, for catch-up vaccination of teenagers and young adults, applying the more recent cancer costs reduced the estimated cost per QALY gained by about $12,400. The cost studies we identified in our literature review are up-to-date and based on reliable data sources from United States settings, and can inform future studies of HPV vaccination cost-effectiveness in the United States. However, careful consideration is warranted to determine the most appropriate cost values to apply.
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Affiliation(s)
- Harrell W Chesson
- a Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Elissa Meites
- b Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Donatus U Ekwueme
- c Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Mona Saraiya
- c Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Lauri E Markowitz
- b Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Polesel J, Lupato V, Collarile P, Vaccher E, Fanetti G, Giacomarra V, Palazzari E, Furlan C, Matrone F, Navarria F, Gobitti C, Minatel E, Serraino D, Birri S, Franchin G. Direct health-care cost of head and neck cancers: a population-based study in north-eastern Italy. Med Oncol 2019; 36:31. [PMID: 30815763 DOI: 10.1007/s12032-019-1256-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Abstract
Improvements in prognosis of head-and-neck squamous cell carcinoma (HNSCC) have paralleled with an increase in health-care costs, so that an economic evaluation is of growing importance. Presently, most of the evidence is from insurance-based studies in the USA. Between 2007 and 2010, 879 HNSCC patients were identified through the population-based cancer registry of the Friuli Venezia Giulia region, including 266 oral, 187 oropharyngeal, 136 hypopharyngeal, and 290 laryngeal cancers. Health-care costs from diagnosis to treatment initiation and in the following 2 years were retrieved through a record linkage with the regional health data warehouse. This database collected comprehensive health information on all resident citizens. Generalized linear models with a gamma distribution and log-link function were applied to model costs. The average health-care cost from diagnosis up to 2 years after treatment initiation was €20,184 (95% confidence interval: €19,634 - 20,733). Heterogeneity emerged according to cancer site, elective treatment, and retreatment for cancer persistence/recurrence (no: €13,896; yes: €24,599; p < 0.001). An advanced stage was associated with increased costs stage (I: €12,969; II: €18,276; III: €26,229; IV: €25,574; p < 0.001) as the result of treatment complexity and elevated frequency of patients retreatment due to recurrence. These findings further support strategies to diagnose patients at an earlier cancer stage and the accurate definition of diagnostic and treatment pathways, to start treating patients when radical unimodal approach is still feasible. Besides the advantage in prognosis due to timely curative treatments, this would reduce the economic burden of cancer treatment.
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Affiliation(s)
- Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy.
| | - Valentina Lupato
- Unit of Otorhinolaryngology, Santa Maria degli Angeli General Hospital, via Montereale 24, 33170, Pordenone, PN, Italy
| | - Paolo Collarile
- Friuli Venezia Giulia Cancer Registry, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy.,Unit of Hygiene and Public Heatlth, Department of Prevention, AAS3 "Alto Friuli-Collinare- Medio Friuli", Via Duodo 82, 33033, Codroipo, UD, Italy
| | - Emanuela Vaccher
- Unit of Medical Oncology A, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Giuseppe Fanetti
- Unit of Radiatherapic Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Vittorio Giacomarra
- Unit of Otorhinolaryngology, Santa Maria degli Angeli General Hospital, via Montereale 24, 33170, Pordenone, PN, Italy
| | - Elisa Palazzari
- Unit of Radiatherapic Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Carlo Furlan
- Unit of Radiotherapy, San Martino Hospital, Viale Europa 22, 32100, Belluno, BL, Italy
| | - Fabio Matrone
- Unit of Radiatherapic Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Federico Navarria
- Unit of Radiatherapic Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Carlo Gobitti
- Unit of Radiatherapic Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Emilio Minatel
- Unit of Radiatherapic Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Silvia Birri
- Unit of Epidemiology, AAS 5 "Friuli Occidentale", via della Vecchia Ceramica 1, 33170, Pordenone, PN, Italy
| | - Giovanni Franchin
- Unit of Radiatherapic Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
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Lairson DR, Wu CF, Chan W, Dahlstrom KR, Tam S, Sturgis EM. Medical Care Cost of Oropharyngeal Cancer among Texas Patients. Cancer Epidemiol Biomarkers Prev 2017; 26:1443-1449. [PMID: 28838945 DOI: 10.1158/1055-9965.epi-17-0220] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/17/2017] [Accepted: 06/09/2017] [Indexed: 12/20/2022] Open
Abstract
Background: The incidence of oropharyngeal cancer is rising rapidly, with the majority of cases being attributable to human papillomavirus (HPV). Despite the availability of a vaccine, rates of HPV vaccination among Texas youth are low. The healthcare cost of oropharyngeal cancer in Texas is unknown. The aims of this study were to estimate the first 2-year cost of treating new cases of oropharyngeal cancer and determine the predictors of oropharyngeal cancer treatment cost in Texas.Methods: This study included a retrospective cohort of 467 Texas patients with commercial insurance claims data with oropharyngeal cancer diagnosed from 2011 to 2014 and a control group of 467 noncancer patients obtained with propensity score matching. Total healthcare cost during the first 2 years after the index date was measured. A generalized linear model was used to identify predictors of monthly cost during the 2 years after the index date.Results: The mean differential adjusted healthcare cost for oropharyngeal cancer cases was $139,749 in the first 2 years. The mean adjusted monthly cost in the first 2 years was $6,693 for cases and $870 for controls. Age, comorbidity, mental health, prediagnostic healthcare cost, and time index were significant predictors of monthly cost.Conclusions: Medical care cost was about $140,000 in the first 2 years after diagnosis of oropharyngeal cancer among commercially insured patients in Texas.Impact: The cost estimates provide important parameters for development of decision-analytic models to inform decision makers about the potential value of initiatives for increasing the HPV immunization rate in the state. Cancer Epidemiol Biomarkers Prev; 26(9); 1443-9. ©2017 AACR.
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Affiliation(s)
- David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.
| | - Chi-Fang Wu
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Kristina R Dahlstrom
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samantha Tam
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Division of Cancer Prevention and Population Sciences, Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Comparison of the efficacy between intensity-modulated radiotherapy and two-dimensional conventional radiotherapy in stage II nasopharyngeal carcinoma. Oncotarget 2017; 8:78096-78104. [PMID: 29100451 PMCID: PMC5652840 DOI: 10.18632/oncotarget.17481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/12/2017] [Indexed: 12/16/2022] Open
Abstract
We compared treatment outcomes in patients with stage II nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT) or two-dimensional conventional radiotherapy (2D-CRT). Stage II (2010 UICC/AJCC staging system) NPC patients treated with IMRT (n = 178) or 2D-CRT (n = 73) between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity score-matching method. The primary endpoint was overall survival (OS). Secondary endpoints were local relapse-free survival (LRFS), regional relapse-free survival (RRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS). Acute and late toxicity reactions to IMRT and 2D-CRT were also compared. In an unmatched cohort of 251 patients, no significant survival differences were found between those receiving IMRT and those receiving 2D-CRT (5-year OS, 95.67% vs 94.44%, P = 0.0556; LRFS, 97.34% vs 98.59%, P = 0.6656; RRFS, 99.26% vs 100%, P = 0.6785; DMFS, 96.5% vs 98.63%, P = 0.7910; DFS, 92.2% vs 97.24%, P = 0.8719). In the propensity-matched cohort of 146 patients, 5-year OS (97.06% vs 94.44%, P = 0.1325), LRFS (96.75% vs 98.59%, P = 0.8869), RRFS (100% vs 100%, P = 1.0000), DMFS (98.63% vs 98.63%, P = 0.4225), and DFS (95.37% vs 97.24%, P = 0.5634) were similar between patients treated with IMRT or 2D-CRT. However, IMRT correlated with fewer acute and late toxicity reactions. Thus although IMRT provides no survival advantage, it has a lower incidence of toxicity than 2D-CRT in stage II NPC patients.
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