Surgery for the primary treatment of T1-T3 oropharynx squamous-cell carcinoma (OPC) does not increase the cost of care, even for patients requiring adjuvant treatment, according to A. Daniel Pinheiro, MD, an otolaryngologist at Mercy Clinic Ear, Nose, and Throat-Surgery Center, Springfield, MO, who presented his findings at the 2016 Multidisciplinary Head and Neck Cancer Symposium.
“With T1-T3 oropharynx cancer, one can start with a primary nonsurgical approach or a surgical approach,” said Dr Pinheiro. “A lot of patients present with advanced disease, particularly in regards to their neck, so a lot of them will require adjuvant treatment. And one of the questions is, ‘Will this lead to increased cost?’”
Dr Pinheiro and colleagues investigated the factors that determine the cost of care in OPC. They identified 299 patients diagnosed with OPC between July 2011 and June 2015. Cost was defined as the reimbursement for all charges in a 6-month episode of care, starting with a biopsy that was positive for OPC.
“Cost reflects the money paid by the patient and third-party payers for treatment, and we wanted to reflect everything that happened related to that episode of care,” said Dr Pinheiro. This included outpatient consultations, imaging studies, laboratory fees, facility fees, inpatient and outpatient procedures, hospitalization, emergency department care, and medications.
A total of 69 patients met the study inclusion criteria. Of the 42 patients who underwent primary surgical procedures, 22 received adjuvant treatment. Overall, 27 patients received nonsurgical treatment, 25 of whom underwent chemoradiation therapy.
Overall, 38 patients in the surgical group and 26 patients in the nonsurgical group were positive for the human papillomavirus p16 subtype.
Cost of Surgical versus Nonsurgical Treatment
The cost was significantly lower for patients who underwent surgery only compared with patients who received nonsurgical treatment ($38,462 vs $83,222, respectively), but surgery followed by adjuvant chemoradiation therapy canceled this difference ($84,598 vs $83,222, respectively).
“We looked at hospital and clinic revenue, and we found that the majority of the revenue to the health system comes from the hospital side,” Dr Pinheiro said. “But when we looked at patients treated primarily surgically or nonsurgically, there was no difference between the 2 in terms of cost.”
“One of the interesting things that we found is that there was a lot of variability, depending on who the treating medical oncologist was,” he added. “Some medical oncologists provide more expensive care than others. We should aim to reduce provider-dependent variability in cost.”
Based on these data, Dr Pinheiro and colleagues concluded that surgical treatment is more cost-effective for early-stage OPC, but surgical and nonsurgical treatment approaches are comparable in cost for more advanced stages of OPC. The highest opportunity for cost-savings is in patients with T1-T3 OPC who do not require adjuvant chemoradiation therapy.