Head and neck cancers in France: an analysis of the hospital medical information system (PMSI) database.
BACKGROUND
With 16,005 new cases and 5,406 related deaths in 2005, France is particularly concerned by Head and Neck (H&N) cancers. In addition to tobacco and alcohol, Human Papillomavirus (HPV) has been reported as a risk factor for H&N cancers. The literature on the burden of these cancers in Europe is scarce. This study was performed to assess the medical and economical burden of hospitalisations for H&N cancers in France.


METHODS
The French national hospital database (PMSI), in which admissions to public and private hospitals are recorded, was retrospectively analysed to assess the annual number of patients hospitalised for H&N cancers and associated hospital costs from the healthcare payer perspective. ICD-10 codes (16 codes classified as oral cavity, oropharynx, pharynx, salivary glands and larynx) were used to extract admissions for these cancers. Hospital stays, chemotherapy and radiotherapy sessions were extracted to assess patients' management. Costs of admissions were obtained from French official tariffs.


RESULTS
In 2007, there were 36 268 patients hospitalised for H&N cancers, of whom 81% were men, corresponding to 60 200 hospital stays and 287 846 sessions of chemo- or radio-therapy. Oropharynx cancer was the most frequent (28% of patients), followed by oral cavity cancer (25% of patients). The peak of frequency was observed in the 55-59 years age group. Patients were mainly treated in medicine (48%) and surgery (23%) units. Mean annual cost per patient ranged from €2,764 to €7,673 leading to a total hospital cost of €323 millions in 2007 (including hospitalization and expensive drugs). With 26% of H&N cancers attributable to HPV infections, 9 430 patients were hospitalized due to HPV-related H&N cancers, representing €138 million in 2007.


CONCLUSIONS
Even without taking into account the rehabilitation costs, the hospital burden of H&N cancers is considerable.
St Guily
Jean Lacau
JL
Biostatistic and Epidemiology Department, Institut Gustave Roussy, Villejuif, France.
Borget
Isabelle
I
Vainchtock
Alexandre
A
Rémy
Vanessa
V
Takizawa
Claire
C
D000367:Age Factors; D005260:Female; D005602:France / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000191:economics / Q000453:epidemiology*; D017721:Hospital Costs; D006751:Hospital Information Systems; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
Cancer Epidemiol Biomarkers Prev. 2005 Feb;14(2):467-75
15734974
Int J Cancer. 2009 Jul 15;125(2):362-6
19330833
Eur J Health Econ. 2004 Feb;5(1):70-80
15452768
J Clin Pathol. 2004 May;57(5):449-55
15113849
Head Neck Oncol. 2009 Oct 14;1:36
19828033
Gastroenterol Clin Biol. 2003 Jan;27(1):22-7
12594362
CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
15761078
Eur J Cancer. 1995 Sep;31A(10):1640-6
7488416
Rev Epidemiol Sante Publique. 2008 Jun;56(3):159-75
18547762
Nat Rev Cancer. 2005 Feb;5(2):127-35
15685196
Eur J Obstet Gynecol Reprod Biol. 2009 Dec;147(2):210-4
19735968
Arch Otolaryngol Head Neck Surg. 1997 May;123(5):513-6
9158399
Int J Oral Maxillofac Surg. 2008 Feb;37(2):135-9
18022348
Health Technol Assess. 2006 Apr;10(14):1-144, iii-iv
16707071
Semin Oncol. 2004 Dec;31(6):744-54
15599852
N Engl J Med. 2007 May 10;356(19):1944-56
17494927
Arch Otolaryngol Head Neck Surg. 2004 Nov;130(11):1269-75
15545580
J Clin Oncol. 2008 Feb 1;26(4):612-9
18235120
Eur J Cancer. 2001 Nov;37(17):2204-11
11677108
J Natl Cancer Inst Monogr. 2001;(29):45-51
11694566
Bull Cancer. 2008 Jan;95(1):5-10
18230564
Gynecol Oncol. 2007 Nov;107(2 Suppl 1):S24-6
17938015
Laryngoscope. 2009 Aug;119(8):1531-7
19489068
Cancer. 2007 Oct 1;110(7):1429-35
17724670
Am J Epidemiol. 2007 Apr 1;165(7):814-20
17244634