title: Costs of care in a matched pair comparison of intensity-modulated radiation therapy (IMRT) versus conventional radiation therapy (CRT) for the treatment of head and neck cancer.
abstract: OBJECTIVE
  Intensity-modulated radiation therapy (IMRT) has been rapidly adopted for the treatment of head and neck cancer. Limited comparative effectiveness data suggest that IMRT reduces the incidence of xerostomia and improves quality of life. We assess the cost of IMRT versus the older conventional radiation therapy (CRT) relative to other potential drivers of cost in patients with head and neck cancer.
  
  
  METHODS
  We compared patients treated with definitive radiation with or without chemotherapy for squamous cell carcinoma of the head and neck treated between 2000 and 2009. IMRT-treated patients were matched to CRT-treated patients by site, stage, and smoking status. Itemized billing charges were obtained for each patient and used to estimate cost using the Medicare fee schedule. Multivariate analysis was used to assess the influence of demographic, clinical, and treatment variables on total, pretreatment, during treatment, and follow-up costs.
  
  
  RESULTS
  Models indicate that compared with CRT, IMRT was associated with, on average, a $5881 increase in total costs (P=0.043), a $1700 decrease in pretreatment costs (P=0.014), a $4768 increase in costs during treatment (P=0.004), and no significant difference in follow-up costs. Positron emission tomography scans, cancer recurrence, and comorbidity were also associated with higher total costs in this sample.
  
  
  CONCLUSIONS
  Use of IMRT relative to CRT was strongly correlated with higher total costs, but disease control, patient comorbidity, and use of positron emission tomography also had significant effects on overall costs. Cost-effectiveness models should be developed to assess whether the potential benefits of IMRT are worth the associated investment.
authors: Departments of *Radiation Oncology †Health Policy and Management, University of North Carolina, Chapel Hill, NC ‡School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA.
authors: Nathan C
authors: NC
authors: Sheets
authors: Stephanie B
authors: SB
authors: Wheeler
authors: Racquel E
authors: RE
authors: Kohler
authors: David V
authors: DV
authors: Fried
authors: Paul M
authors: PM
authors: Brown
authors: Bhishamjit S
authors: BS
authors: Chera
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000191:economics / Q000532:radiotherapy*; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000191:economics / Q000532:radiotherapy*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000191:economics*; D049268:Positron-Emission Tomography / Q000191:economics; D011878:Radiotherapy / Q000191:economics / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D017211:Treatment Failure