Cost comparison of treatment for oropharyngeal carcinoma

Abstract

Objectives/Hypothesis: Based on current guidelines, surgical and nonsurgical therapies are viable frontline treatment for patients with locoregional oropharyngeal carcinoma (OPC). We sought to compare financial parameters between chemoradiation and transoral robotic surgery (TORS) in this patient population.Study Design: Case-control study.Methods: In this study we identified patients with selected American Joint Committee on Cancer 7th Edition stage II to IVa OPC treated with TORS between January 2013 and December 2014. Fifteen patients who underwent TORS were stage matched with 15 patients treated with chemoradiation. Total charges and cost data for each patient were analyzed at 4-month and 1-year time points; functional and oncologic outcomes were assessed.Results: There were no significant differences in functional and oncologic outcomes. Patients undergoing TORS had a longer inpatient hospital stay, and most required a nasogastric tube for an average of 3.5 days. There were no local or regional recurrences. Across all time points, the TORS group had lower charges and costs compared to the chemoradiation group, with 14% lower costs at 1 year. In the chemoradiation group, nearly two-thirds of costs came from radiation therapy and pharmacy expenses. Chemotherapy accounted for most pharmacy costs. The costs of operating the surgical robot accounted for a about half of surgical costs.Conclusions: Selected patients with stage II to IVa oropharyngeal carcinoma treated with TORS may incur lower costs than those treated nonsurgically. With rising healthcare spending, the financial impact of treatment might be considered for those patients eligible for treatment regimens with comparable functional and oncologic outcomes.

The dawn of robotic surgery in otolaryngology-head and neck surgery

“…The cost burdens are certainly a major disadvantage of the da Vinci system, and they may limit its accessibility to both medical operators and patients. However, for the carefully selected OPC patient with minimal risk of needing postoperative radiation therapy, frontline transoral eHNS might actually save as much as 10-24% compared to radiation therapy with concurrent chemotherapy (50). In developing countries, cost burdens are even larger obstacles and thus become a hindrance to global development.…”

Preoperative predictors of difficult oropharyngeal exposure for transoral robotic surgery: The Pharyngoscore

“…Many studies have outlined that despite the high expenses associated with the acquisition of surgical robots and special instrumentation, TORS is a more cost‐effective option with respect to exclusive (C)RT for the treatment of oropharyngeal carcinoma in the United States, as it allows to lower the use of adjuvant (C)RT thus reducing the short‐ and long‐term morbidities related to (C)RT 52–56 . Anyways, this issue is still debated may not be applied to other countries with different health systems.…”

An Analysis of 1‐Year Charges for Head and Neck Cancer: Targets for Value‐Based Interventions

“…Health care decisions are increasingly made with an emphasis on value due to rapidly rising health care costs. 10,11 The overall costs of treating cancer increased by 75% in a 10-year period from 1995 to 2004, and the continued projected increase in cost is expected to exceed $150 billion in 2020. 5,12 A multitude of cost reduction strategies in cancer have been implemented or are in the process of being implemented, including telemedicine, 13 drug waste reduction, 14 and earlier palliative care consultation.…”