Cost considerations in the treatment of oropharyngeal squamous cell carcinoma

Objectives. To determine the cost of treatment of oropharyngeal squamous cell carcinoma (OP SCCA) with transoral surgery with concomitant neck dissection (TOS), TOS with adjuvant radiation therapy (TOS + RT), TOS with adjuvant chemoradiation therapy (TOS + CRT), and primary chemoradiation therapy (CRT).Study Design. Case series.Setting. Two tertiary care teaching hospitals.Subjects and Methods. Using the databases of 2 teaching hospitals, patients were identified who had OP SCCA treated with TOS, TOS + RT, TOS + CRT, and primary CRT in 2009 to 2010. Costs were analyzed from an institutional perspective looking at reimbursement. Patients with government payers and patients with private payers in each group were identified, and net revenue data obtained for the 3-month period from diagnosis were calculated and averaged for each group. Cost was defined as the reimbursement for all charges surrounding the 3-month episode of treatment. All revenue associated with inpatient and outpatient care, including pharmacy charges, was included.Results. The mean cost of TOS (private payers/government payers) was $37,435/$15,664 (range, $22,486-$48,746/$13,325-$16,885). The mean cost of TOS + RT (private payers/government payers) was $74,484/ $34,343 (range, $72,400-$84,825/$31,565-$40, 810). The mean cost of TOS + CRT (private payers/government payers) was $191,780/$53,245 (range, $145,450-$217,220/ $49,400-$58,325). The mean cost of CRT (private payers/government payers) was $198,285/$57,429 (range, $168,216-$298, 945/$52,900-$59,545).Conclusion. An algorithm of transoral surgical treatment of OP SCCA with adjuvant treatment as indicated by pathology is more cost conscious than an algorithm of treatment of all OP SCCA with CRT.