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Costs of Posttreatment Surveillance for Patients With Upper Aerodigestive Tract Cancer
Katherine S. Virgo, PhD;
Randal C. Paniello, MD;
Frank E. Johnson, MD
Arch Otolaryngol Head Neck Surg. 1998;124:564-572.
Objectives To determine the range of recommended follow-up strategies for patients with upper aerodigestive tract cancer treated with curative intent and to estimate the cost of follow-up.
Design Economic analyses of the costs associated with 31 follow-up strategies (12 generic and 19 site specific) identified from a MEDLINE search of the literature for 1978 to 1997 and a search of major textbooks. Generic strategies are not specific for site or histology and are exclusive of strategies designed for the rare patient, ie, patients who would not be considered average in terms of clinical characteristics. Charge data obtained from the Part B Medicare Annual Data File and the Hospital Outpatient Bill File were used as a proxy for cost.
Setting Ambulatory care.
Main Outcome Measures Nationwide Medicare-allowed charges and an actual-charge proxy for 5 years of surveillance after treatment for upper aerodigestive tract cancer.
Results Medicare-allowed charges for 5-year follow-up ranged from a low of $739 to a high of $14079 for the generic and site-specific strategies combined and from $739 to $4646 for the 12 generic strategies alone. When Medicare-allowed charges were converted to a proxy for actual charges using a conversion ratio of 1.62, the range was $1198 to $22807 for all strategies combined (a 19-fold difference in charges) and $1198 to $7597 for the generic strategies alone (a 5-fold difference in charges).
Conclusions Charges vary extensively across surveillance strategies, particularly if site-specific strategies are considered, although the potential benefit of more intensive, higher-cost strategies on survival or quality of life has yet to be demonstrated.
From the Department of Surgery, St Louis University Health Sciences Center (Drs Virgo and Johnson), Surgical Service, St Louis Department of Veterans Affairs Medical Center (Drs Paniello and Johnson), and Department of Otolaryngology, Washington University School of Medicine (Dr Paniello), St Louis, Mo.
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