Economic burden of resected squamous cell carcinoma of the head and neck in an incident cohort of patients in the UK

Abstract

BackgroundSCCHN is the sixth most common cancer worldwide. Locally advanced SCCHN continues to be a therapeutic challenge with high rates of morbidity and mortality and a low cure rate. Despite the apparent impact of SCCHN on patients and presumably society, the economic burden of the treatment of resected SCCHN patients in the UK has not been investigated.MethodsThis retrospective data analysis was based on in- and outpatient care records extracted from Hospital Episode Statistic database and linked to mortality data in the UK. SCCHN patients with resection of lip, tongue, oral cavity, pharynx or larynx were followed for at least one year (max. of 5 years) from the date of first resection.ResultsA total of 11,403 patients (mean age 63.2 years, 69.8% males) who met study criteria were followed for an average of 31 months. 32.3% of patients died in the follow-up period and the mean time to death was 16.9 months. In the first year, mean number of days of hospitalization and number of outpatient visits was 21.6 and 4.2, respectively; mean number of reconstructive and secondary surgeries was 0.32 and 0.14 per patient, respectively; 4.7% of the patients received radiotherapy and 12.2% received chemotherapy. From the second to fifth year healthcare utilizations rates were lower. Mean cost of post-operative healthcare utilization was £23,212 over 5 years (£19,778 for the first year and £1477, £847, £653 and £455 for years 2-5). Total cost of post-operative healthcare utilisation was estimated to be £255.5 million over the 5-year follow-up.ConclusionsIn the UK, SCCHN patients after surgical resection needed considerable healthcare resources and incurred substantial costs. Study findings might provide a useful source for clinicians and decision makers in understanding the economic burden of managing SCCHN in the UK and also suggests a need for new therapies that could improve outcomes and reduce the disease burden.

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

“…In the UK, Kim et al [37] examined data from 11,403 patients after resection for HNC and estimated that the cost to the NHS totaled £255.5 million over a possible 5-year follow-up (2008–2009 £). The study by Hollenbeak et al [78] of linked SEER–Medicare data of an elderly HNC cohort ( n  = 10,711) reported that, over 5 years, excess costs to Medicare of HNC care would total US$369 million (2010 US$) compared with a matched cohort of patients without HNC.…”

Systematic review and evidence synthesis of non-cervical human papillomavirus-related disease health system costs and quality of life estimates

“…This includes a combination of treatment received at different stages of disease. For example, Kim et al 43 reported postoperative management cost for a selective group of patients with head and neck cancer who had received surgical resection 43…”

Fluorouracil plasma monitoring: systematic review and economic evaluation of the My5-FU assay for guiding dose adjustment in patients receiving fluorouracil chemotherapy by continuous infusion

“…In contrast, advanced diseases with unresectable H&N SCCs are treated by concurrent chemoradiotherapy as a palliative therapy mainly to improve survival. 43 Costs of treatment for (only surgical resection) and caring for H&N SCCs after surgery are substantial. Kim et al 43 have reported the total cost of post-operative health-care utilisation over the 5-year follow-up.…”

“…43 Costs of treatment for (only surgical resection) and caring for H&N SCCs after surgery are substantial. Kim et al 43 have reported the total cost of post-operative health-care utilisation over the 5-year follow-up. The cost was approximately £255.5M for 11,403 patients in the UK.…”

“…After 3 years around 36% of the resection patients survived, compared with none in the palliation group. Few details of the costing are presented, with the median costs being estimates £8070 [£13,444] for Kim et al 43 undertook a retrospective data analysis of the inpatient and outpatient records of 11,403 UK patients with resected SCC of the H&N, accessed through the Health Episode Statistics. Among survivors the mean costs per year rapidly declined after the first year and continued to decline thereafter as shown in Table 102.…”