Comparative cost analysis between definitive radiotherapy and transoral surgery for oropharyngeal squamous cell carcinoma: A SEER-Medicare analysis

• Published in: Oral oncology 2021-01, Vol.112, p.105029-105029, Article 105029
• Main Authors: Sher, David J., Yan, Jingsheng, Day, Andrew T., Khan, Saad, Zhu, Hong
• Format: Article
• Language: English
• Subjects: Comparative effectiveness; Cost; Oropharyngeal cancer; Radiation; Transoral surgery
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2020.105029

•Primary transoral surgery was generally associated with the lowest total cost.•The addition of concurrent chemotherapy was the most powerful driver of cost.•There was no difference in medication costs between primary surgery and radiation.•Age, comorbidity, smoking, and black race predicted significantly more expense.•Cisplatin chemotherapy was the least expensive concurrent regimen. Primary radiotherapy (RT) and transoral surgery (TOS) are effective local therapy treatments for oropharyngeal squamous cell carcinoma (OPSCC), but their cost profiles differ. We compared the one-year costs of these competing treatments using a large claims-based database. Eligible individuals were patients in the SEER-Medicare registry diagnosed with OPSCC between 2000 and 2011. Patients were categorized as receiving either primary RT +/− chemotherapy, or TOS +/− adjuvant RT or chemoradiotherapy (CRT), and all treatment costs from 1 month prior to diagnosis to 1 year after diagnosis were calculated. Univariable and multivariable linear regression models were used to determine predictors of payer expenditure. Patient-borne pharmacy costs were also analyzed. The cohort included 3497 patients (73% RT, 27% TOS), of whom 73% were locally advanced. The mean total 13 month costs for RT alone, CRT, TOS alone, TOS + RT and TOS + CRT were $39,083, $63,537, $25,468, $36,592, and $99,919, respectively, for early-stage patients. For locally advanced individuals, the mean costs were $45,049, $68,099, $40,626, $53,729, and $71,397, respectively. On multivariable analysis, the adjusted increase in total costs versus RT alone were $21,844, −$5431, $7984, and $28,581 for CRT, TOS alone, TOS + RT, and TOS + CRT, respectively. The difference between CRT and TOS + RT became non-significant for TOS patients undergoing transoral surgery plus neck dissection. Cisplatin was associated with significant less cost than cetuximab and taxane-based chemotherapy. In this population of elderly patients, transoral surgery was generally associated with less expensive treatment, with the addition of chemotherapy serving as the main driver of increased cost.