Head and neck cancer (HNC) is the sixth most common malignancy globally, and poses a substantial economic burden to payers, healthcare systems, and patients. Costs associated with HNC are driven by complex treatment pathways and the need for involvement of several medical specialties. |
Studies published from 2003 to 2013 mainly examined direct costs of HNC, using data for the USA. Few reports were available in the literature describing indirect costs of the disease. Direct costs of treatment appeared to be the main driver of costs of HNC. In comparison, costs associated with diagnosis, treatment-related side effects, or follow-up care were minimal. |
Considerable variation among studies regarding the specific type of HNC within the patient population, data sources, costing years, and healthcare systems made meaningful comparisons challenging given the available evidence. Prospective studies, such as patient registries or trials with economic endpoints, are needed to facilitate a systematic evaluation of the economic burden of HNC and comparative value of alternative treatment modalities. |
1 Introduction
1.1 Definition
1.2 Epidemiology
1.3 Management
1.4 Research Objective
2 Methods
3 Results
3.1 Societal Costs of Head and Neck Cancer (HNC)
3.2 Total Direct Medical Costs of HNC
3.3 Per-Patient Direct Medical Costs
3.3.1 Excess Cost Approach
References | Country | Parameter | Year of reported costs | Reported cost |
---|---|---|---|---|
Excess cost approach | ||||
USA | ||||
Hollenbeak et al. [78] | USA | Total 5-years costs | 2010 | US$79,165 |
Total 5-year costs for controls | US$44,676 | |||
Jacobson et al. [34] | USA | Annual healthcare costs for commercially insured patients | 2009 | US$71,151 |
Annual healthcare costs for Medicare patients | US$35,890 | |||
Annual healthcare costs for Medicaid patients | US$44,541 | |||
Kim Le et al. [38] | USA | Total costs for metastatic cancer over 6 months | 2008 | US$65,412 |
Total costs for metastatic cancer controls over 6 months | US$3,168 | |||
Total costs for recurrent locally advanced cancer over 6 months | US$25,837 | |||
Total costs for recurrent locally advanced cancer controls over 6 months | US$2,752 | |||
Lang et al. [41] | USA | Mean Medicare payments | 1998 | US$48,847 |
Mean Medicare payments for controls | US$23,305 | |||
Mean Medicare payments for distant cancer | US$53,741 | |||
Mean Medicare payments for regional cancer | US$58,387 | |||
Mean Medicare payments for local cancer | US$42,698 | |||
Mean Medicare payments for in situ cancer | US$37,434 | |||
Ray et al. [54] | USA | Mean monthly total healthcare costs for patients with dermatologic side effect | 2010 | US$12,539 |
Mean monthly total healthcare costs for patients without dermatologic side effect | US$9,684 | |||
Reveles et al. [55] | USA | Median total direct cost pre-cetuximab approval | NR | US$110,099 |
Median total direct cost post-cetuximab approval | US$111,156 | |||
Attributable cost approach | ||||
Europe | ||||
Kim et al. [37] | UK | Mean annual postoperative healthcare utilization | 2008–2009 | £23,212 |
USA | ||||
Amonkar et al. [9] | USA | Mean annual healthcare costs | 2008 | US$34,450 |
Coughlan and Frick [20] | USA | Mean cost per case (condition approach) | 2008 | US$14,573 |
Mean cost per case (attributable approach) | US$4,788 | |||
Rest of world | ||||
Pinto and Uga [51] | Brazil | Mean total cost of treatment for laryngeal cancer over 6 years | 2006 | R$37,529 |
Mean total cost of treatment for laryngeal cancer for the first year of treatment | R$27,667 |
3.3.2 Attributable Cost Approach
3.4 Overall Direct Medical Costs
3.5 Cost Analyses: Diagnostic Methods
3.5.1 Imaging
3.5.2 Telemedicine
3.6 Cost Analyses: Treatment Approaches
Reference | Country | Parameter | Year of reported costs | Reported cost |
---|---|---|---|---|
Surgery | ||||
Europe | ||||
Bodard et al. [12] | France | Cost of extraoral repositioning system used during surgery | NR | €50 |
Cost of intraoral repositioning system used during surgery | €30 | |||
Hammoudi et al. [77] | France | Cost savings of transoral robotic surgery (vs. conventional surgery) per case treated | NR | $7,134a
|
O’Connor et al. [79] | Europe | Cost of a positive SLNB pathway result per patient | NR | €17,186–18,244 |
Cost of a negative SLNB pathway result per patient | €4,715 | |||
Cost of a false negative SLNB pathway result per patient | €17,834–19,014 | |||
Cost of traditional surgical approach for stage II oral tumor per patient | €27,515 | |||
Cost of traditional surgical approach for stage I oral tumor per patient | €15,043–15,378 | |||
USA | ||||
Gourin et al. [27] | USA | Mean hospital cost of partial laryngectomy | 2009 | US$23,623 |
Mean hospital cost of total laryngectomy/laryngopharyngectomy | US$50,980 | |||
Mean hospital cost of pedicled or free flap reconstruction | US$17,083 | |||
Gourin et al. [28] | USA | Mean hospital cost of partial glossectomy | 2009 | US$17,410 |
Mean hospital cost of total glossectomy | US$25,990 | |||
Mean hospital cost of pharyngectomy | US$19,715 | |||
Mean hospital cost of mandibulectomy | US$19,593 | |||
Mean hospital cost of neck dissection | US$19,528 | |||
Mean hospital cost of pedicled or free flap reconstruction | US$17,641 | |||
Gourin and Frick [30] | USA | Mean hospital cost of partial laryngectomy | 2011 | US$30,092 |
Mean hospital cost of total laryngectomy/laryngopharyngectomy | US$37,908 | |||
Mean hospital cost of neck dissection | US$28,715 | |||
Mean hospital cost of pedicled or free flap reconstruction | US$30,038 | |||
Gourin and Frick [29] | USA | Mean hospital cost of partial glossectomy | 2011 | US$24,041 |
Mean hospital cost of total glossectomy | US$25,935 | |||
Mean hospital cost of laryngectomy | US$26,615 | |||
Mean hospital cost of tonsillectomy | US$13,763 | |||
Mean hospital cost of pharyngectomy | US$20,824 | |||
Mean hospital cost of mandibulectomy | US$19,673 | |||
Mean hospital cost of neck dissection | US$23,341 | |||
Mean hospital cost of pedicled or free flap reconstruction | US$22,679 | |||
Li et al. [43] | USA | Mean hospital cost of partial glossectomy | 2012 | US$25,810 |
Mean hospital cost of total glossectomy | US$34,459 | |||
Mean hospital cost of mandibulectomy | US$32,167 | |||
Mean hospital cost of neck dissection | US$30,710 | |||
Mean hospital cost of pedicled or free flap reconstruction | US$31,021 | |||
Maddox and Davies [44] | USA | Mean hospital charge for laryngectomy in 1997 | 2008 | US$58,000 |
Mean hospital charge for laryngectomy in 2008 | US$109,000 | |||
Richmon et al. [56] | USA | Mean hospital cost of pedicled or free flap reconstruction | 2012 | US$33,798 |
Mean hospital cost of transoral robotic surgery | US$16,262 | |||
Rest of world | ||||
Brookes et al. [14] | Canada | Cost savings of resection with tracheostomy site sutured (vs. not sutured) per patient | NR | C$11,609 |
Smeele et al. [62] | Canada | Mean total cost of pectoralis major myocutaneous flap reconstruction | NR | C$20,400 |
Mean total cost of free flap reconstruction | C$23,600 | |||
Radiotherapy | ||||
USA | ||||
Razfar et al. [82] | USA | Cost of IMRT for oral pharyngeal cancer per patient | NR | US$165,537 |
Cost of traditional XRT for oral pharyngeal cancer per patient | US$87,922 | |||
Cost of IMRT for early stage cancer per patient | US$97,563 | |||
Cost of traditional XRT for early stage cancer per patient | US$63,374 | |||
Cost of surgery for early stage cancer per patient | US$61,265 | |||
Cost of IMRT for advanced stage cancer per patient | US$52,034 | |||
Cost of traditional XRT for advanced stage cancer per patient | US$78,046 | |||
Sheets et al. [61] | USA | Total cost of IMRT (vs. CRT) per patient | NR | US$5,881 |
Pretreatment cost of IMRT (vs. CRT) per patient | −US$1,700 | |||
Cost during treatment of IMRT (vs. CRT) per patient | US$4,768 | |||
Follow-up cost of IMRT (vs. CRT) per patient | US$2,288 | |||
Rest of world | ||||
Donato et al. [23] | Canada | Costs for immobilization devices used during radiation therapy for the Uvex system | 2004 | C$141 |
Costs for immobilization devices used during radiation therapy for the Ultraplast system | C$82.10 | |||
Chemotherapy | ||||
Europe | ||||
Fountzilas et al. [26] | Greece | Cost of PGEM chemotherapy per patient | 2005 | €7,419 |
Cost of PPLD chemotherapy per patient | €11,068 | |||
Greskovich et al. [31] | Greece | Cost of inpatient administration (vs. outpatient) of cisplatin per patient | NR | US$18,664 |
USA | ||||
Crandley et al. [21] | USA | Cost of TPF induction added to platinum chemoradiation per patient | NR | US$189,321 |
Cost of platinum chemoradiation without TPF induction per patient | US$150,270 |