title: Treatment patterns and economic burden of metastatic and recurrent locally-advanced head and neck cancer patients.
abstract: OBJECTIVE
  To characterize treatment patterns and measure the economic burden associated with metastatic (mHNC) and recurrent, locally-advanced head and neck cancer (rHNC).
  
  
  METHODS
  Administrative claims from Medicare- and privately-insured individuals during 2004-2008 were used in this retrospective database study of patients with advanced HNC. Patients diagnosed with HNC were matched 1:1 to cancer-free controls to measure the incremental economic burden of HNC. Outcomes of interest were measured during the 6 months following the date of a secondary tumor diagnosis for metastatic patients or the date of a diagnosis indicating rHNC. To assess treatment patterns, HNC patients were evaluated for the use frequency of treatments (radiotherapy, chemotherapy and surgery). Costs were reported in 2008 US$ from a third-party payer perspective and were analyzed using generalized linear models and two-part regression models adjusting for differences in age and baseline Charlson Comorbidity Index (excluding cancer diagnoses) between the HNC and control cohorts. Components of cost included inpatient, outpatient and other medical services as well as pharmacy costs.
  
  
  RESULTS
  The mHNC cohort consisted of 1042 patients and the rHNC cohort included 324 patients. The most common treatments for mHNC patients were supportive care (90.2%), radiation therapy (48.5%), surgery (41.9%) and chemotherapy (38.3%). Patients with rHNC frequently received HNC-related supportive care (71.0%), radiation therapy (67.9%) and chemotherapy (27.2%); HNC-related surgery was infrequent (12.7%) during the study period. The 6-month incremental adjusted total costs were $60,414 per patient for mHNC and $21,141 per patient for rHNC (p<0.0001). Approximately 46-58% of the incremental cost was attributable to outpatient visits, 27-37% to inpatient costs and 11-13% to pharmacy, depending on the HNC cohort.
  
  
  CONCLUSIONS
  The identification of mHNC/rHNC was based on diagnosis codes and treatment patterns with the limitation of the claims database.
  
  
  CONCLUSIONS
  Metastatic and recurrent, locally-advanced HNC patients frequently receive cancer-related treatments and incur substantial economic burden.
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kim Le
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Winfree
authors.forename: Hongbo
authors.initials: H
authors.lastname: Yang
authors.forename: Maryna
authors.initials: M
authors.lastname: Marynchenko
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Yu
authors.forename: Christian
authors.initials: C
authors.lastname: Frois
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
mesh_terms: D000368:Aged; D017281:Cost of Illness; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000191:economics* / Q000628:therapy; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014481:United States