Economic burden of resected squamous cell carcinoma of the head and neck in a US managed-care population

Abstract

Background:

Squamous cell carcinoma of the head and neck (SCCHN) places a high burden on society and poses complex challenges to healthcare providers.

Methods:

Retrospective claims-based analysis of commercially insured patients identified between 01-31-04 and 12-31-07 with diagnostic evidence of cancer of the lip, tongue, oral cavity, pharynx, or larynx who underwent surgical resection during identification period. Outcomes included treatment patterns, healthcare utilization, and costs. All study variables were analyzed descriptively.

Results:

Among the 1104 patients in the final study sample, 71.9% were male, with mean age 56.6 years. On average, patients were followed for 830 days (range of mean days: 805 for lip or tongue cancer to 847 for pharyngeal cancer). About half received radiation therapy during follow-up, whereas only 16.2% received chemotherapy. Patients with pharyngeal cancer were most likely to undergo chemotherapy. After their index surgery, 57.9% of patients had ≥1 inpatient stay, 44.9% had ≥1 ER visit, and all had ≥1 ambulatory visit. The percentage with ≥1 inpatient stay post-index was highest among patients with pharyngeal cancer (73.0%) and lowest in the laryngeal cancer cohort (49.5%). Mean number of hospitalized days, ER visits, and ambulatory visits was 0.45, 0.69, and 27.4, respectively, per-patient per-year. Overall, patients incurred ∼$94 million in cost following index surgery ($85,000 per-person, on average). Mean total healthcare cost was $34,450 per-patient per-year, the bulk of which comprised medical expenses ($32,401). The highest mean healthcare cost was incurred by the pharyngeal cancer cohort ($40,214).

Conclusions:

Patients with resected SCCHN incur substantial healthcare costs and have high utilization rates. Results of this analysis are primarily applicable to resected SCCHN in a managed-care setting, and therefore may not be generalizable to the entire US population. Furthermore, disease stage is an important factor impacting outcomes, but these analyses did not stratify patients according to disease stage.

Key words::

• Chemotherapy
• Claims analysis
• Cost of illness
• Head and neck cancer
• Outcomes assessment

Transparency

Declaration of funding

This study was funded by GlaxoSmithKline.

Declaration of financial/other relationships

M.M.A. is employed by GlaxoSmithKline, the funder of this study. B.C. and N.S. are employed by Innovus, the company hired by GlaxoSmithKline to conduct this study, and A.T. is employed by i3 Research.

Acknowledgments

The authors thank Victoria Porter, medical writer, i3 Innovus, for her assistance with the preparation of this manuscript.

A poster based on this study, titled ‘Economic burden of resected squamous cell carcinoma of the head and neck (SCCHN) in a US managed-care population,’ was presented at the 2010 ASCO annual meeting, Chicago, Illinois, June 4–8, 2010.