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Kathleen Lang, PhD; Matthew Sussman, MA; Mark Friedman, MD; Jun Su, MD; Hong J. Kan, PhD; David Mauro, MD; Eskinder Tafesse, PhD; Joseph Menzin, PhD

Arch Otolaryngol Head Neck Surg. 2009;135(6):582-588.

Objective  To evaluate the incidence and costs of complications due to radiotherapy alone vs platinum-based chemoradiotherapy among patients diagnosed as having advanced squamous cell carcinoma of the head and neck (ASCCHN) from a payer perspective.

Design  Retrospective cohort study.

Setting  Data from the PharMetrics Patient-Centric Database from June 2000 through June 2006.

Patients  The study included patients with ASCCHN and an indication of a secondary malignant neoplasm (both identified based on International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes), 124 of whom were treated with radiotherapy alone and 77 of whom were treated with chemoradiotherapy (including 53 with cisplatin plus radiotherapy, 26 with carboplatin plus radiotherapy, and 2 with cisplatin and carboplatin plus radiotherapy). The patients were assigned to 1 of 2 cohorts based on treatment type—radiotherapy only and platinum-based chemoradiotherapy—and were followed up for 6 months.

Main Outcome Measures  Incidence and costs of treatment-related complications associated with chemotherapy in ASCCHN.

Results  We found significantly (P < .001) higher rates of treatment-related complications among patients receiving chemoradiotherapy (86%) than among patients receiving only radiotherapy (51%). The mean per-patient costs associated with treatment-related complications were approximately $10 000 higher among patients who received chemoradiotherapy than among those treated with radiotherapy alone (P < .001). These costs represented 17% of the total costs during follow-up for patients who received chemoradiotherapy and 11% of costs for those who received radiotherapy. The most expensive complications were dehydration and/or electrolyte imbalance and oral complications.

Conclusions  Our study results suggest that the attributable incidence and costs of treatment-related complications associated with chemotherapy in ASCCHN are substantial. The emergence of safer treatments may have the advantage of alleviating this cost burden.

Author Affilitiations: Boston Health Economics, Inc, Waltham, Massachusetts (Drs Lang, Friedman, and Menzin and Mr Sussman); and Bristol-Myers Squibb, Wallingford, Connecticut (Drs Su, Kan, Mauro, and Tafesse). Dr Mauro is now with Merck & Co, Inc, West Point, Pennsylvania. Dr Tafesse is now with AstraZeneca Pharmaceuticals, LP, Wilmington, Delaware.

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