Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Int J Radiat Oncol Biol Phys. 2021 Jun 1;110(2):396-402. doi: 10.1016/j.ijrobp.2020.12.021. Epub 2020 Dec 23.
De-escalated treatment for human papillomavirus (HPV)+ oropharynx squamous cell carcinoma (OPSCC) has shown promising initial results. Health-care policy is increasingly focusing on high-value care. This analysis compares the cost of care for HPV+ OPSCC treated with definitive chemoradiation (CRT), surgery and adjuvant radiation (RT), and surgery and de-escalated CRT on MC1273.
MC1273 is a prospective, phase 2 study evaluating adjuvant CRT to 30 to 36 Gy plus docetaxel for HPV+ OPSCC after surgery for high-risk patients. Matched standard-of-care control groups were retrospectively identified for patients treated with definitive CRT or adjuvant RT. Standardized costs were evaluated before radiation, during treatment (during RT), and at short-term (6 month) and long-term (7-24 month) follow-up periods.
A total of 56 definitive CRT, 101 adjuvant RT, and 66 MC1273 patients were included. The CRT arm had more T3-4 disease (63% vs 17-21%) and higher N2c-N3 disease (52% vs 20-24%) vs both other groups. The total treatment costs in the CRT, adjuvant RT, and MC1273 groups were $47,763 (standard deviation [SD], $19,060], $57,845 (SD, $17,480), and $46,007 (SD, $9019), respectively, and the chemotherapy and/or RT costs were $39,936 (SD, $18,480), $26,603 (SD, $12,542), and $17,864 (SD, $3288), respectively. The per-patient, per-month, average short-term follow-up costs were $3860 (SD, $10,525), $1072 (SD, $996), and $972 (SD, $833), respectively, and the long-term costs were $978 (SD, $2294), $485 (SD, $1156), and $653 (SD, $1107), respectively. After adjustment for age, T-stage, and N-stage, treatment costs remained lower for CRT and MC1273 versus adjuvant RT ($45,450 and $47,114 vs $58,590, respectively; P < .001), whereas the total per-patient, per-month follow-up costs were lower in the MC1273 study group and adjuvant RT versus CRT ($853 and $866 vs $2030, respectively; P = .03).
MC1273 resulted in 10% and 20% reductions in global costs compared with standard-of-care adjuvant RT and definitive CRT treatments. Substantial cost savings may be an added benefit to the already noted low toxicity and maintained quality of life of treatment per MC1273.
针对人乳头瘤病毒（HPV）+口咽鳞状细胞癌（OPSCC）的降阶梯治疗已显示出有希望的初步结果。医疗保健政策越来越关注高价值的护理。本分析比较了在 MC1273 上接受确定性放化疗（CRT）、手术和辅助放疗（RT）以及手术和降阶梯 CRT 治疗的 HPV+ OPSCC 患者的护理成本。
MC1273 是一项前瞻性、II 期研究，评估了 HPV+ OPSCC 高危患者手术后接受 30 至 36 Gy 辅助 CRT 加多西他赛的辅助 CRT。为接受确定性 CRT 或辅助 RT 的患者回顾性确定了标准护理对照。在放疗前、治疗期间（在 RT 期间）以及短期（6 个月）和长期（7-24 个月）随访期间评估标准化成本。
共纳入 56 例确定性 CRT、101 例辅助 RT 和 66 例 MC1273 患者。CRT 组 T3-4 期疾病（63% vs 17-21%）和更高的 N2c-N3 期疾病（52% vs 20-24%）多于其他两组。CRT、辅助 RT 和 MC1273 组的总治疗费用分别为 47763 美元（标准差[SD]，19060 美元）、57845 美元（SD，17480 美元）和 46007 美元（SD，9019 美元），化疗和/或 RT 费用分别为 39936 美元（SD，18480 美元）、26603 美元（SD，12542 美元）和 17864 美元（SD，3288 美元）。每位患者、每月、平均短期随访的费用分别为 3860 美元（SD，10525 美元）、1072 美元（SD，996 美元）和 972 美元（SD，833 美元），长期费用分别为 978 美元（SD，2294 美元）、485 美元（SD，1156 美元）和 653 美元（SD，1107 美元）。在调整年龄、T 期和 N 期后，与辅助 RT 相比，CRT 和 MC1273 的治疗费用仍然较低（分别为 45450 美元和 47114 美元 vs 58590 美元；P <.001），而 MC1273 研究组和辅助 RT 的每位患者每月随访费用均低于 CRT（分别为 853 美元和 866 美元 vs 2030 美元；P =.03）。
与标准护理辅助 RT 和确定性 CRT 治疗相比，MC1273 使全球成本降低了 10%和 20%。与 MC1273 治疗的低毒性和维持的生活质量相比，大量的成本节约可能是一个额外的好处。
