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Cost of Squamous Cell Cancer of the Head and Neck

The cost of squamous cell cancer of the head and neck is driven primarily by the end-of-life phase. Treatment costs increased following the approval of cetuximab.
Published Online: Jun 22,2017
Ivan A. Reveles, PharmD, MS; Kelly R. Reveles, PharmD, PhD; Bradi L. Frei, PharmD, MS; Christopher R. Frei, PharmD, MS; and Jim M. Koeller, MS
Objectives: The costs of diagnostic, treatment, and end-of-life phases for advanced squamous cell carcinoma of the head and neck (SCCHN) are unknown, particularly after the approval of the first biologic agent for treatment, cetuximab. We aimed to characterize costs for each of the 3 disease phases and total cost of care for patients with advanced SCCHN before and after the approval of cetuximab.
Study Design: Retrospective, observational, cohort study.
Methods: This was a retrospective analysis of the PharMetrics Choice insurance claims database. Patients 20 years or older with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes suggestive of advanced SCCHN between March 1, 2003, and March 1, 2008, were included. Patients were divided into 2 cohorts by date of diagnosis: a “prebiologic” period and a “postbiologic” period. Descriptive statistics were used to summarize baseline patient characteristics, monthly and total medical costs, and cost drivers. The Mann-Whitney U test was used to compare medical costs between segments and cohorts.
Results: A total of 365 patients with SCCHN met the study criteria. Median monthly medical costs were: diagnosis ($2199), treatment ($4161), end-of-life ($6614), and total ($4167). Total medical costs were driven primarily by outpatient costs (23%), inpatient costs (18%), and the cost of radiation therapy (16%). In the treatment segment, median monthly costs were significantly lower in the prebiologic era compared with the postbiologic era ($3301 vs $4381; P = .0024).
Conclusions: Median total costs exceeded $4000 per month for patients with SCCHN, driven primarily by the end-of-life segment. The median monthly costs of the treatment segment increased by approximately $1000 following cetuximab’s approval.
Am J Pharm Benefits. 2017;9(3):-0

Head and neck cancers account for approximately 3% of all cancer diagnoses and 2% of cancer-related deaths in the United States.1 In 2015, an estimated 45,780 Americans were diagnosed with head and neck cancers, of which 90% were of squamous cell histology.1-3

Currently, the estimated 5-year survival rate for all patients diagnosed with squamous cell carcinoma of the head and neck (SCCHN) is 60%. Of those diagnosed with SCCHN, 60% are diagnosed with locally or regionally advanced disease, generally denoting a poorer prognosis.1,4,5

Fortunately, recent data from the American Cancer Society demonstrate a steady annual decrease in SCCHN mortality of approximately 2% for women. Mortality in men has since stabilized.The decrease in mortality is likely attributable to advances in the management of head and neck cancers.1 The National Comprehensive Cancer Network clinical practice guidelines recommend combined modality therapy for patients diagnosed with locally or regionally advanced disease.

Currently, first-line recommendations include combining radiation therapy with chemotherapy (eg, cisplatin) or with biologic therapy.5 Cetuximab is a biologic therapy, an epidermal growth factor receptor inhibitor approved in 2006 for use in patients with locally or regionally advanced SCCHN in combination with radiation therapy.6-8

Second-line options include surgery, radiation (if not previously given), or systemic therapy with various single-agent chemotherapeutic options: cisplatin, carboplatin, docetaxel, cetuximab, or fluorouracil.5

With the rising cost of cancer care in the United States, new therapies must be critically evaluated in regard to their economic value. Multiple factors, including extent of care, advancements in diagnostic capabilities, and increases in cancer prevalence rates, have contributed to this rise in recent years.9-11