Economic and Clinical Burden of Recurrence Among Elderly Patients With Resected Locoregionally Advanced Head and Neck Squamous Cell Carcinoma (LA HNSCC) in the US
Author(s)
Dandan Zheng, PhD1, Su Zhang, PhD2, Behzad Bidadi, MD1, Nati Lerman, MD1, Yan Song, PhD2, Rui Song, PhD2, Jiayang Li, PhD2, Anyu Zhu, MS2, Yuexin Tang, PhD1, James Signorovitch, PhD2, Sanjay Merchant, PhD1, Glenn J. Hanna, MD3;
1Merck & Co., Inc., Rahway, NJ, USA, 2Analysis Group, Inc., Boston, MA, USA, 3Dana-Farber Cancer Institute, Boston, MA, USA
1Merck & Co., Inc., Rahway, NJ, USA, 2Analysis Group, Inc., Boston, MA, USA, 3Dana-Farber Cancer Institute, Boston, MA, USA
Presentation Documents
OBJECTIVES: Real-world evidence on the economic and clinical burden of recurrence following primary surgery in LA HNSCC is limited. This study evaluated the impact of recurrence on overall survival (OS), healthcare resource utilization (HRU), and healthcare costs among elderly patients treated in the US.
METHODS: A retrospective cohort study using SEER-Medicare data included patients with newly diagnosed (2007-2019) stage III-IVB LA HNSCC (larynx, hypopharynx, oral cavity, or oropharynx) who underwent primary resection within 4 months after initial diagnosis. For patients with recurrence, index date was 30 days before recurrence; for those without recurrence, it was randomly assigned to match the time elapsed from primary treatment initiation to the index date in the recurrence cohort. Post-index OS, HRU, and healthcare costs (2023 USD) were compared between cohorts.
RESULTS: The study included 333 patients with recurrence (Cohort 1; median follow-up: 17.1 months) and 169 patients without recurrence (Cohort 2; median follow-up: 26.6 months). Baseline characteristics between the cohorts were comparable. HPV status and smoking status were not available. Patients with recurrence had significantly shorter OS post-index (median OS: 23.8 vs. 44.4 months; adjusted hazard ratio=1.63, p<0.001). Patients with recurrence incurred significantly more all-cause per-patient-per-month (PPPM) HRU: the recurrence cohort had more inpatient admissions (0.16 vs 0.11; adjusted incidence rate ratio [aIRR]=1.73), outpatient visits (3.15 vs 1.67; aIRR=2.00), and days hospitalized (2.08 vs 1.56; aIRR=1.86), respectively (all p<0.01). Post-index all-cause healthcare costs PPPM were also significantly higher in the recurrence cohort: total medical, inpatient, and outpatient costs were $3,732, $1,756, and $1,607 higher in patients with recurrence, respectively (all p<0.001).
CONCLUSIONS: Recurrence following primary surgery was associated with significantly worse OS and increased HRU and healthcare costs among elderly patients with surgically treated LA HNSCC. The findings highlight a patient population where more effective therapies are needed.
METHODS: A retrospective cohort study using SEER-Medicare data included patients with newly diagnosed (2007-2019) stage III-IVB LA HNSCC (larynx, hypopharynx, oral cavity, or oropharynx) who underwent primary resection within 4 months after initial diagnosis. For patients with recurrence, index date was 30 days before recurrence; for those without recurrence, it was randomly assigned to match the time elapsed from primary treatment initiation to the index date in the recurrence cohort. Post-index OS, HRU, and healthcare costs (2023 USD) were compared between cohorts.
RESULTS: The study included 333 patients with recurrence (Cohort 1; median follow-up: 17.1 months) and 169 patients without recurrence (Cohort 2; median follow-up: 26.6 months). Baseline characteristics between the cohorts were comparable. HPV status and smoking status were not available. Patients with recurrence had significantly shorter OS post-index (median OS: 23.8 vs. 44.4 months; adjusted hazard ratio=1.63, p<0.001). Patients with recurrence incurred significantly more all-cause per-patient-per-month (PPPM) HRU: the recurrence cohort had more inpatient admissions (0.16 vs 0.11; adjusted incidence rate ratio [aIRR]=1.73), outpatient visits (3.15 vs 1.67; aIRR=2.00), and days hospitalized (2.08 vs 1.56; aIRR=1.86), respectively (all p<0.01). Post-index all-cause healthcare costs PPPM were also significantly higher in the recurrence cohort: total medical, inpatient, and outpatient costs were $3,732, $1,756, and $1,607 higher in patients with recurrence, respectively (all p<0.001).
CONCLUSIONS: Recurrence following primary surgery was associated with significantly worse OS and increased HRU and healthcare costs among elderly patients with surgically treated LA HNSCC. The findings highlight a patient population where more effective therapies are needed.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE128
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology