Cost-minimisation and cost-effectiveness analysis comparing transoral CO2 laser cordectomy, laryngofissure cordectomy and radiotherapy for the treatment of T1–2, N0, M0 glottic carcinoma

Abstract

The financial costs of laryngeal cancer treatment are a notable burden on healthcare budgets. In this study, we assess whether CO2 laser surgery is cheaper than radiotherapy or laryngofissure and cordectomy in the treatment of T1-2, N0, M0 glottic squamous cell carcinoma. 56 patients with a mean age of 65.88 years (SD = 10.04), 53 men and 3 women, with T1-2, N0, M0 glottic squamous cell carcinoma were retrospectively analysed. We conducted a comparative analysis of costs associated with three treatments: carbon dioxide laser cordectomy (n = 21), radiotherapy (n = 20), and laryngofissure cordectomy (n = 15). Complications of the radiotherapy and surgical treatments, need for tracheotomy and its permanence, length of hospital stay, occupation and ability to work and economic costs of treatments were recorded. Cost-minimisation and cost-effectiveness analysis were obtained. The cost of transoral laser cordectomy (2,289.79 euro) is statistically significantly lower than that of radiotherapy (4,804.72 euro) or laryngofissure cordectomy (13,229.75 euro) (p < 0.001). Transoral carbon dioxide laser surgery is the best option in terms of cost-effectiveness for the treatment of T1-2, N0, M0 glottic cancer.

The Economic Burden of Head and Neck Cancer: A Systematic Literature Review

“…Studies assessing the costs of hospitalization in HNC have been conducted in Thailand [71], Spain [22], France [63], the UK [66], and the USA [33, 43, 56]. While it is not possible to compare these costs across different countries and healthcare systems, each study concluded that the burden of hospitalization costs is high.…”

“…Interestingly, the authors attributed €138 million of this cost to the 26 % of HNC caused by HPV infections [63]. A retrospective study of patients treated for glottic cancer in Spain found that mean hospital costs per day were €600–700 (costing year NR) [22]. While the vast majority of database studies are done in Western countries, a study using national health data in Thailand reported that, in 2010, hospital charges totaled 691 million Thai baht (THB) (at the time, US$21.8 million), or THB26,556 (US$838) for each of the 26,012 admissions for diagnosis and treatment of HNC [71].…”

“…Nine studies in the USA, two in Canada, two in France, two in Spain, and one across Europe assessed costs of different surgical approaches for HNC [12, 14, 22, 27–30, 43, 44, 56, 58, 62, 77, 79]. …”

“…In Spain, transoral carbon dioxide laser cordectomy was found to be much less costly (€2,290) than laryngofissure cordectomy (€13,230) (costing year NR) [22] in treating patients with glottic cancer. A retrospective study of 21 patients with an SCC of the upper aero-digestive tract treated at a French hospital found that transoral robotic surgery (TORS) was significantly less expensive than conventional surgery, requiring fewer tracheotomies, shortening stays, and saving $7,134 (specific currency not reported) [77].…”

“…In the Spanish study, laryngofissure cordectomy (€13,230) was more than double the cost of radiotherapy (€4,805) (costing year NR) [22]. Similarly, in the Dutch study, in which costs of diagnosis, treatment, follow-up, and complications were considered, surgery was associated with greater costs than radiotherapy, largely driven by an increase in the number of inpatient days.…”