This presentation is part of: Poster Session - Clinical Strategies; Judgment and Decison Making
THE COST-EFFECTIVENESS OF SURGERY PLUS RADIATION FOR REGIONAL ORAL CAVITY CANCER IN THE ELDERLY
Christopher S. Hollenbeak, PhD, Penn State College of Medicine, Surgery & Health Evaluation Sciences, Hershey, PA, Brendan C. Stack, MD, Penn State College of Medicine, Otolaryngology-HNS, Hershey, PA, and Jay F. Piccirillo, MD, Washington University School of Medicine, Otolarygology, St. Louis, MO.
Purpose. Treatment for regional cancer of the lip and oral cavity may consist of surgery or surgery followed by radiation. The purpose of this research was to determine whether the addition of a course of radiation therapy following surgery for regional cancer of the lip and oral cavity was cost-effective compared to single modality surgery. Methods. We studied 660 Medicare patients treated for known regional cancer of the lip and oral cavity with surgery plus radiation (N=337) or surgery alone (N=323) between 1984 and 1994 using the SEER-Medicare linked database. We first estimated survival functions for these patients stratified by treatment modality using the product limit estimator of Kaplan and Meier. We next computed average accumulated costs up to five years, stratified by treatment. Finally, we estimated the cost-effectiveness of surgery plus radiation compared to surgery alone by computing an incremental cost-effectiveness ratio. The incremental cost-effectiveness ratio represents the additional cost per life saved in five years if a treatment strategy of surgery plus radiation were used instead of surgery alone. Results. As seen in the figure, five years after diagnosis, 59% of patients with treated with surgery plus radiation had survived compared to 40% of patients receiving surgery alone (p=0.0007). Furthermore, in spite of the added cost of radiation, patients receiving surgery plus radiation also had lower average five-year costs than patients receiving surgery alone (313,302 vs. 149,884). Combining the five-year survival and accumulated costs implies an incremental cost-effectiveness ratio of -$909,091 per life saved, which implies that surgery plus radiation dominates surgery alone. Conclusions. Radiation in addition to surgery is highly cost-effective in the treatment of regional cancer of the lip and oral cavity in elderly Medicare patients. In this study of 660 Medicare patients, radiation plus surgery had both lower average costs and lower mortality rates at five years. Further research is needed to determine whether these findings are obtained for other sites and stages of disease and for younger head and neck cancer patients.
