Cost Comparison of Surgery vs Organ Preservation for Laryngeal Cancer

Abstract

Objective: To perform a cost minimization analysis of total laryngectomy with postoperative radiotherapy vs induction chemotherapy with subsequent radiotherapy in patients with advanced (stage III or IV) squamous cell carcinoma of the larynx.Design: Decision-analysis model using data from peerreviewed trials, case series, meta-analyses, and Medicare diagnosis related group reimbursement rates. Setting and Patients:A hypothetical cohort of patients with stage III or IV laryngeal cancer. The perspective is that of a health care payer. Interventions:The hypothetical patient cohort could receive (1) surgery (total laryngectomy) with postoperative radiotherapy or (2) induction chemotherapy (fluorouracil and cisplatin) with radiotherapy followed by salvage surgery for patients failing to respond to chemotherapy.Main Outcome Measure: Overall difference in direct medical costs in 2003 US dollars between the 2 treatment arms from initiation to completion of treatment. Results:In the baseline analysis, the direct medical costs for the surgical arm were $30138 per patient. For the organ preservation arm, the direct medical costs were $33052 per patient. The finding that the surgical arm costs were lower was robust to all sensitivity analyses except for the extreme low estimate for the cost of chemotherapy. Conclusions:Our results suggest that total laryngectomy with postoperative radiotherapy costs nearly $3000 less than organ preservation treatment for advanced laryngeal cancer. Given that survival appears equivalent between the 2 modalities, cost consideration and patient preference may be important factors in decision making for the treatment of advanced laryngeal cancer.

Resection margins and other prognostic factors regarding surgically treated glottic carcinomas

“…Laryngeal cancer represents one of the most common head and neck malignancies, accounting for approximately 1.2% of all new cancer cases in Western societies [1,2]. Laryngeal cancer mostly affects middle-aged men with a history of tobacco and alcohol use.…”

“…Male to female ratio is currently 5:1 with an expected increase in the proportion of women affected by laryngeal cancer during years to come [1]. Due to the important physiologic functions of the larynx as well as the increased incidence of the disease, cancer of the larynx is associated with significant morbidity and mortality for the patient, in addition to increased financial costs for society [2,3].…”

“…Multiple options are available for the management of glottic cancer today [3,4]. Certain features, such as tumor exact location, the presence of cartilage invasion, and patient and physician choice, influence the treatment decision [2,4]. During recent years a great focus towards improved functional outcome has been given by most physicians treating patients with glottic cancer [5].…”

The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia

“…Surgeons can contribute to the decision-making process by conducting rigorous, systematic analyses of the costs and benefits of interventions. There has been a recent surge in the number of economic analyses published in the surgical literature [11,12,17,28,40,50].…”

A Cost and Benefit Study of Esophagectomy for Patients with Esophageal Cancer

“…However, most of them were more interesting in discussing results of different treatment methods, follow-up protocols, or both. [7][8][9][10][11][12][13][14][15] Till now, there are only a few literatures which had discussed about the potentially large medical expense in treating esophageal cancer patients. [16][17] For the era of limited medical budget, appropriate selection of treatment strategies should include the consideration of treatment expense.…”