title: Treatments and costs for recurrent and/or metastatic squamous cell carcinoma of the head and neck in the Netherlands.
abstract: For patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), chemotherapy can prolong life and alleviate symptoms. However, expected gains may be small, not necessarily outweighing considerable toxicity and high costs. Treatment choice is to a large extent dependent on preferences of doctors and patients and data on these choices are scarce. The purpose of this study is to obtain real-world information on palliative systemic treatment and costs of R/M SCCHN in the Netherlands. In six Dutch head and neck treatment centers, data were collected on patient and tumor characteristics, treatment patterns, disease progression, survival, adverse events, and resource use for R/M SCCHN, between 2006 and 2013. 125 (14 %) out of 893 R/M SCCHN patients received palliative, non-trial first-line systemic treatment, mainly platinum + 5FU + cetuximab (32 %), other platinum-based combination therapy (13 %), methotrexate monotherapy (27 %) and capecitabine monotherapy (14 %). Median progression-free survival and overall survival were 3.4 and 6.0 months, respectively. 34 (27 %) patients experienced severe adverse events. Mean total hospital costs ranged from € 10,075 (± € 9,891) (methotrexate monotherapy) to € 39,459 (± € 21,149) (platinum + 5FU + cetuximab). Primary cost drivers were hospital stays and anticancer drug treatments. Major health care utilization and costs are involved in systemically treating R/M SCCHN patients with a limited survival.
authors: Institute for Medical Technology Assessment, Erasmus University Rotterdam, Woudestein location (J5-51), P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. vanderlinden@bmg.eur.nl.
authors: Naomi
authors: N
authors: van der Linden
authors: VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. j.buter@vumc.nl.
authors: Jan
authors: J
authors: Buter
authors: Merck KGaA, Frankfurter Str. 250, F135/101, 64293, Darmstadt, Germany. chris.pescott@merckgroup.com.
authors: Chris P
authors: CP
authors: Pescott
authors: Division of Medical Oncology, Department of Internal Medicine, GROW, School of Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. roy.lalisang@mumc.nl.
authors: Roy I
authors: RI
authors: Lalisang
authors: Netherlands Cancer Institute/Antoni van Leeuwenhoek, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands. j.d.boer@nki.nl.
authors: Jan Paul
authors: JP
authors: de Boer
authors: University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. a.degraeff@umcutrecht.nl.
authors: Alexander
authors: A
authors: de Graeff
authors: Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. carla.vanherpen@radboudumc.nl.
authors: Carla M L
authors: CM
authors: van Herpen
authors: Erasmus Medical Center, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands. r.j.baatenburgdejong@erasmusmc.nl.
authors: Robert J
authors: RJ
authors: Baatenburg de Jong
authors: Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. uyl@bmg.eur.nl.
authors: Carin A
authors: CA
authors: Uyl-de Groot
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends
keywords: Carcinoma, squamous cell of head and neck; Costs and cost analysis; Drug therapy