Dataset Information

Medical Care Cost of Oropharyngeal Cancer among Texas Patients.

ABSTRACT: Background: The incidence of oropharyngeal cancer is rising rapidly, with the majority of cases being attributable to human papillomavirus (HPV). Despite the availability of a vaccine, rates of HPV vaccination among Texas youth are low. The healthcare cost of oropharyngeal cancer in Texas is unknown. The aims of this study were to estimate the first 2-year cost of treating new cases of oropharyngeal cancer and determine the predictors of oropharyngeal cancer treatment cost in Texas.Methods: This study included a retrospective cohort of 467 Texas patients with commercial insurance claims data with oropharyngeal cancer diagnosed from 2011 to 2014 and a control group of 467 noncancer patients obtained with propensity score matching. Total healthcare cost during the first 2 years after the index date was measured. A generalized linear model was used to identify predictors of monthly cost during the 2 years after the index date.Results: The mean differential adjusted healthcare cost for oropharyngeal cancer cases was $139,749 in the first 2 years. The mean adjusted monthly cost in the first 2 years was $6,693 for cases and $870 for controls. Age, comorbidity, mental health, prediagnostic healthcare cost, and time index were significant predictors of monthly cost.Conclusions: Medical care cost was about $140,000 in the first 2 years after diagnosis of oropharyngeal cancer among commercially insured patients in Texas.Impact: The cost estimates provide important parameters for development of decision-analytic models to inform decision makers about the potential value of initiatives for increasing the HPV immunization rate in the state. Cancer Epidemiol Biomarkers Prev; 26(9); 1443-9. ©2017 AACR.

SUBMITTER: Lairson DR

PROVIDER: S-EPMC5903433 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Medical Care Cost of Oropharyngeal Cancer among Texas Patients.

Lairson David R DR Wu Chi-Fang CF Chan Wenyaw W Dahlstrom Kristina R KR Tam Samantha S Sturgis Erich M EM

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 20170824 9

<b>Background:</b> The incidence of oropharyngeal cancer is rising rapidly, with the majority of cases being attributable to human papillomavirus (HPV). Despite the availability of a vaccine, rates of HPV vaccination among Texas youth are low. The healthcare cost of oropharyngeal cancer in Texas is unknown. The aims of this study were to estimate the first 2-year cost of treating new cases of oropharyngeal cancer and determine the predictors of oropharyngeal cancer treatment cost in Texas.<b>Met ...[more]

PMID: 28838945

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Project description:Making complex medical decisions is becoming an increasingly challenging task due to the growing amount of available evidence to consider and the higher demand for personalized treatment and patient care. IT systems for the provision of clinical decision support (CDS) can provide sustainable relief if decisions are automatically evaluated and processed. In this paper, we propose an approach for quantifying similarity between new and previously recorded medical cases to enable significant knowledge transfer for reasoning tasks on a patient-level. Methodologically, 102 medical cases with oropharyngeal carcinoma were analyzed retrospectively. Based on independent disease characteristics, patient-specific data vectors including relevant information entities for primary and adjuvant treatment decisions were created. Utilizing the ϕK correlation coefficient as the methodological foundation of our approach, we were able to determine the predictive impact of each characteristic, thus enabling significant reduction of the feature space to allow for further analysis of the intra-variable distances between the respective feature states. The results revealed a significant feature-space reduction from initially 19 down to only 6 diagnostic variables (ϕK correlation coefficient ≥ 0.3, ϕK significance test ≥ 2.5) for the primary and 7 variables (from initially 14) for the adjuvant treatment setting. Further investigation on the resulting characteristics showed a non-linear behavior in relation to the corresponding distances on intra-variable level. Through the implementation of a 10-fold cross-validation procedure, we were further able to identify 8 (primary treatment) matching cases with an evaluation score of 1.0 and 9 (adjuvant treatment) matching cases with an evaluation score of 0.957 based on their shared treatment procedure as the endpoint for similarity definition. Based on those promising results, we conclude that our proposed method for using data-driven similarity measures for application in medical decision-making is able to offer valuable assistance for physicians. Furthermore, we consider our approach as universal in regard to other clinical use-cases, which would allow for an easy-to-implement adaptation for a range of further medical decision-making scenarios.

Project description:BackgroundProton therapy is a promising advancement in radiation oncology especially in terms of reducing normal tissue toxicity, although it is currently expensive and of limited availability. Here we estimated the individual quality of life benefit and cost-effectiveness of proton therapy in patients with oropharyngeal cancer treated with definitive radiation therapy (RT), as a decision-making tool for treatment individualization.Methods and materialsNormal tissue complication probability models were used to estimate the risk of dysphagia, esophagitis, hypothyroidism, xerostomia and oral mucositis for 33 patients, comparing delivered photon intensity-modulated RT (IMRT) plans to intensity-modulated proton therapy (IMPT) plans. Quality-adjusted life years (QALYs) lost were calculated for each complication while accounting for patient-specific conditional survival probability and assigning quality-adjustment factors based on complication severity. Cost-effectiveness was modeled based on upfront costs of IMPT and IMRT, and the cost of acute and/or long-term management of treatment complications. Uncertainties in all model parameters and sensitivity analyses were included through Monte Carlo sampling.ResultsThe incremental cost-effectiveness ratios (ICERs) showed considerable variability in the cost of QALYs spared between patients, with median $361,405/QALY for all patients, varying from $54,477/QALY to $1,508,845/QALY between individual patients. Proton therapy was more likely to be cost-effective for patients with p16-positive tumors ($234,201/QALY), compared to p16-negative tumors ($516,297/QALY). For patients with p16-positive tumors treated with comprehensive nodal irradiation, proton therapy is estimated to be cost-effective in ≥ 50% of sampled cases for 8/9 patients at $500,000/QALY, compared to 6/24 patients who either have p16-negative tumors or receive unilateral neck irradiation.ConclusionsProton therapy cost-effectiveness varies greatly among oropharyngeal cancer patients, and highlights the importance of individualized decision-making. Although the upfront cost, societal willingness to pay and healthcare administration can vary greatly among different countries, identifying patients for whom proton therapy will have the greatest benefit can optimize resource allocation and inform prospective clinical trial design.

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Dataset Information

Medical Care Cost of Oropharyngeal Cancer among Texas Patients.

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Medical Care Cost of Oropharyngeal Cancer among Texas Patients.

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