title: Costs of treatment intensification for head and neck cancer: concomitant chemoradiation randomised for radioprotection with amifostine.
abstract: This study presents an overview of costs of a chemoradiation protocol in head and neck cancer patients and an analysis of whether prevention of acute toxicity with amifostine results in a reduction to costs. Fifty-four patients treated with weekly paclitaxel concomitant with radiation were randomised for treatment with subcutaneously administered amifostine (500 mg) and analysed with respect to costs of treatment. Total costs for work-up, treatment and toxicity were calculated per treatment arm. No significant differences were found between treatment arms in preliminary results regarding response (98%), toxicity and 2-year survival (77%). Average costs for toxicity were Euro 3.789, largely influenced by hospital admissions (Euro 3.013). Total costs for amifostine administration amounted to Euro 6.495 per patient. The average total costs of treatment were Euro 19.647 versus Euro 13.592 with or without amifostine, respectively. The applied (subcutaneous) dose of amifostine appeared to be insufficient for radioprotection and reduction of related costs in the concomitant chemoradiation scheme, whereas total costs increased remarkably. Although it would be accompanied by a further cost raise, applying a higher amifostine dose might reduce (mucosal) toxicity and therefore in the long run lower related costs for hospital admission and tube feeding.
authors.affiliation: Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands.
authors.forename: Marijel
authors.initials: M
authors.lastname: Braaksma
authors.forename: Michel
authors.initials: M
authors.lastname: van Agthoven
authors.forename: Wideke
authors.initials: W
authors.lastname: Nijdam
authors.forename: Carin
authors.initials: C
authors.lastname: Uyl-de Groot
authors.forename: Peter
authors.initials: P
authors.lastname: Levendag
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D004999:Amifostine / Q000191:economics / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods; D003131:Combined Modality Therapy; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000517:prevention & control*; D011837:Radiation-Protective Agents / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D011837:Radiation-Protective Agents; D004999:Amifostine