Analysis of Charges Associated with Definitive Nonsurgical Therapy for Early-Stage Lateralized Tonsil Cancer

Abstract

Objective The cost of treatment as it affects comparative effectiveness is becoming increasingly more important. Since cost data is not readily available, we aimed to evaluate the charges associated with definitive non-surgical therapy for early-stage lateralized tonsil cancers. Methods Patients treated with unilateral radiation therapy (RT) for T1 or T2 tonsil cancer patients between 1995 and 2007 were retrospectively reviewed. Total and radiation-specific charges, from 3 months before to 4 months after radiation, were adjusted for inflation. All facets of treatment were evaluated for significant associations with total billing. Results Eighty-four patients were identified. Three-year OS, DSS, and RFS were 97% (95% CI: .88-.99), 98% (95%CI: 0.89–1), and 96% (95%CI: 0.88–0.99), respectively. The median for radiation-specific charges was $60,412 (range $16,811–$84,792). The median for total charges associated with treatment was $109,917 (range $36,680–$231,895). Total billing for treatment was significantly associated with the year of diagnosis (p =0.008), intensity-modulated radiation therapy versus wedge pair RT (p=0.005), pre-radiation direct laryngoscopy (p<0.0001), chemotherapy (p<0.0001), gastrostomy tube placement (p=0.004), and post-radiation neck dissection (p=0.005). Conclusions Although cost data for treatment is not readily available, historically, the recovery rate is approximately 30%. The charges associated with definitive non-surgical therapy for early-stage lateralized tonsil cancer have a wide range likely due to treatment-related procedures, the use of chemotherapy, and evolving RT technologies. These benchmark data are important given renewed interested in primary surgery for tonsil cancer. Cost of care, disease control, and functional outcomes will be critical for comparisons of effectiveness when selecting treatment modalities.