Presentation: S037
Topic: Value and Quality in H&N Surgery (Value-Based Care)
Type: Oral
Date: Thursday, April 27, 2017
Session: 1:00 PM - 2:00 PM Value-Based H&N Cancer Care
Authors: Shin Jeong, PhD, Carol M Lewis, MD, Associate, Professor
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Institution(s): MD Anderson Cancer Center
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Background: Head and neck carcinomas are one of the most frequent tumor diseases. Due to different multimodal and multidisciplinary treatment options, the treatment cost shows a big variation. However, the evidence on the effectiveness by stage and cost-effectiveness of treatment modality is limited. The objective of this study is to determine the effectiveness and cost-effectiveness of each treatment modality for early and late oropharyngeal cancer at diagnosis in a cancer care facility. Cost-effectiveness analysis were performed among patients received surgery, surgery with radiation, surgery with chemo-radiation, chemo-radiation alone and radiation only.

Methods: A retrospective study was conducted using chart review in an oropharyngeal cancer care program in a metropolitan area. Patients on oropharyngeal cancer stage by early (T1 and T2) and late (T3 and T4) at diagnosis from January 1, 2015 to October 31, 2015 were identified. They were categorized into six treatment groups, as surgery, surgery with radiation, surgery with chemo-radiation, surgery with chemotherapy, combined chemo-radiation and radiation only. Effectiveness was measured in life months and quality adjusted life months (QALMs). Medical care cost was defined as a US dollar amount charged to the third-party payer or patient for the period from the first diagnosis date until the end of study or death. Treatment effectiveness was measured in life months gained and quality adjusted life months gained. Twelve-month cancer-specific survival rate was the proportion of the patients with one-year follow-up who did not die of the cancer within the same period. The average health state utility in oropharyngeal care was gained from other literatures.

Results: Of the 93 patients, 70% of patients received combined chemo-radiation, and 11%, 9%, 5%, 3%, 2% of them got radiation alone, surgery, surgery with radiation, surgery along with chemo-radiation and chemotherapy, respectively. Patients with surgery experienced 8.16 QALMs and the patients with other treatment modality experienced 6.72 QALMs in overall. Incremental cost effectiveness ratios (ICER) for surgery (10% of the early cancer patients) vs. surgery with radiation (7%) were $20,833 per QALM gained, and ICER for surgery with radiation vs. surgery with chemo-radiation (4%) was $18, 236. However, ICERs for surgery with chemo-radiation vs. chemo-radiation (64%) and chemo-radiation vs. radiation (14%) were ‘not cost-effective’ in early stage cancer care group. The treatment of chemotherapy alone was excluded in the comparison, as the treatment strategy as a palliative care doesn’t have the same goal of effectiveness to compare. ICER for surgery (5%) vs chemo-radiation (90%) was $ 14,569 per QALM gained. Hence, surgery performs better in both of the groups.

Conclusion:  Surgery is more effective and cost-effective than other strategies for oropharyngeal cancer treatment. And, total oropharyngeal care cost increases as treatment strategies become more expensive. However, this research finding might be relevant when it comes to relatively short-term observational periods. Future studies with a longer observational time frame are expected.

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