Cost of squamous cell cancer of the head and neck

Objectives: The costs of diagnostic, treatment, and end-of-life phases for advanced squamous cell carcinoma of the head and neck (SCCHN) are unknown, particularly after the approval of the first biologic agent for treatment, cetuximab. We aimed to characterize costs for each of the 3 disease phases and total cost of care for patients with advanced SCCHN before and after the approval of cetuximab. Study Design: Retrospective, observational, cohort study. Methods: This was a retrospective analysis of the PharMetrics Choice insurance claims database. Patients 20 years or older with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes suggestive of advanced SCCHN between March 1, 2003, and March 1, 2008, were included. Patients were divided into 2 cohorts by date of diagnosis: a “prebiologic” period and a “postbiologic” period. Descriptive statistics were used to summarize baseline patient characteristics, monthly and total medical costs, and cost drivers. The Mann-Whitney U test was used to compare medical costs between segments and cohorts. Results: A total of 365 patients with SCCHN met the study criteria. Median monthly medical costs were: diagnosis ($2199), treatment ($4161), end-of-life ($6614), and total ($4167). Total medical costs were driven primarily by outpatient costs (23%), inpatient costs (18%), and the cost of radiation therapy (16%). In the treatment segment, median monthly costs were significantly lower in the prebiologic era compared with the postbiologic era ($3301 vs $4381; P =.0024). Conclusions: Median total costs exceeded $4000 per month for patients with SCCHN, driven primarily by the end-of-life segment. The median monthly costs of the treatment segment increased by approximately $1000 following cetuximab’s approval.