Evaluating the supportive care costs of severe radiochemotherapy-induced mucositis and pharyngitis : results from a Northwestern University Costs of Cancer Program pilot study with head and neck and nonsmall cell lung cancer patients who received care at a county hospital, a Veterans Administration hospital, or a comprehensive cancer care center.
BACKGROUND
Few studies have examined the costs of supportive care for radiochemotherapy-induced mucosits/pharyngitis among patients with head and neck cancer (HNC) or lung cancers despite the documented negative clinical impact of these complications.


METHODS
The authors identified a retrospective cohort of patients with HNC or nonsmall lung cancer (NSCLC) who had received radiochemotherapy at 1 of 3 Chicago hospitals (a Veterans Administration hospital, a county hospital, or a tertiary care hospital). Charts were reviewed for the presence/absence of severe mucositis/pharyngitis and the medical resources that were used. Resource estimates were converted into cost units obtained from standard sources (hospital bills, Medicare physician fee schedule, Red Book). Estimates of resources used and direct medical costs were compared for patients who did and patients who did not develop severe mucositis/pharyngitis.


RESULTS
Severe mucositis/pharyngitis occurred in 70.1% of 99 patients with HNC and in 37.5% of 40 patients with NSCLC during radiochemotherapy. The total median medical costs per patient were USD 39,313 for patients with mucositis/pharyngitis and USD 20,798 for patients without mucositis/pharyngitis (P = .007). Extended inpatient hospitalization accounted for USD 12,600 of the increased medical costs (median 14 days [USD 19,600] with severe mucositis/pharyngitis vs 5 days [USD 7,000] without; P = .017). For patients who had HNC with mucositis/pharyngitis, incremental inpatient hospitalization costs were USD 14,000, and total medical costs were USD 17,244. For patients who had NSCLC with mucositis/pharyngitis, these costs were USD 11,200 and USD 25,000, respectively.


CONCLUSIONS
In the current study, the medical costs among the patients with HNC and NSCLC who received radiochemotherapy were greater for those who developed severe mucositis/pharyngitis than for those who did not.
Nonzee
Narissa J
NJ
Robert H. Lurie Comprehensive Cancer Center and Division of Hematology/Oncology, Northwestern University, Chicago, Illinois 60611, USA.
Dandade
Neal A
NA
Patel
Urjeet
U
Markossian
Talar
T
Agulnik
Mark
M
Argiris
Athanassios
A
Patel
Jyoti D
JD
Kern
Robert C
RC
Munshi
Hidayatullah G
HG
Calhoun
Elizabeth A
EA
Bennett
Charles L
CL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000191:economics; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000532:radiotherapy / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000532:radiotherapy / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000191:economics* / Q000209:etiology / Q000628:therapy; D010612:Pharyngitis / Q000191:economics* / Q000209:etiology / Q000628:therapy; D010865:Pilot Projects; D011832:Radiation Injuries / Q000191:economics*; D012189:Retrospective Studies
D000970:Antineoplastic Agents