Segmented and total direct cost-of-care for advanced squamous cell carcinoma of the head and neck in a privately insured population
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Introduction: Current treatment recommendations for advanced SCCHN include the use of combined modality therapy (e.g., radiation plus chemotherapy/biologic therapy). The new biologic agent, cetuximab, is considered a primary cost driver for SCCHN management. Cetuximab’s impact, however, has not been factored into SCCHN cost estimates; furthermore, costs have not been delineated for diagnostic, treatment, and end-of-life segments of advanced SCCHN management. We aim to characterize SCCHN segmented and overall costs, before and after cetuximab’s approval. Methods: This was a retrospective analysis of the PharMetrics Choice database. Patients >20 years of age with ICD-9-CM codes suggestive of advanced SCCHN diagnosed between 3/1/2003 and 3/1/2008 were included. Patients were divided into cohorts by diagnosis date: “pre-biologic” and “post-biologic.” Descriptive statistics were used to summarize patient characteristics, monthly and total medical costs, and cost drivers. The Mann-Whitney U test was used to compare costs between segments and cohorts; whereas, least squares regression was used to ascertain the impact of covariates. Results: A total of 365 patients met study criteria. Patients were predominately male (78%), with a median age of 57 years. Median monthly costs were: diagnosis ($2,199), treatment ($4,161), end-of-life ($6,614), and total ($4,167). Total direct medical costs were primarily driven by outpatient costs (23%). Patient age and length of follow-up had a significant impact on total costs, with older age associated with lower costs. When treatment segment was isolated, median monthly costs were lower in the “pre-biologic” as compared to the “post-biologic” era ($3,301 vs. $4,381, p=0.0024); biologic therapy accounted for 4.2% of total cost in the study period. In those patients experiencing all segments of care (“benchmark group”), median monthly costs were: diagnosis ($1,733), treatment ($8,265), end-of-life ($6,614), and total ($7,817). There were no significant differences in monthly medical costs between cohorts for the benchmark group. Conclusions: Median total cost exceeded $4,000/month for SCCHN patients; treatment and end-of-life segments incurred higher costs. Outpatient costs were the biggest cost-driver. Median monthly cost for the treatment segment increased by approximately $1,000 following cetuximab’s approval; however, this difference dissipated when the analysis was limited to those patients who experienced all segments of care.