Overall survival (OS) of patients with recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) is extremely poor. New therapeutic options emerge but need to establish their economic value. The objective was to describe OS and costs in French R/M SCCHN patients.
The EGB, a random representative sample (1/97th) of the French national healthcare system claims database was used. All adult patients with a diagnosis of SCCHN with a first R/M between Jan 2009 and Dec 2014 were selected. Data were analyzed from the index date (first chemotherapy) until patients’ death or Dec 2015 (minimum follow-up of 12 months). Two periods were distinguished: ‘chemotherapy treatment’ (CT) and ‘end-of-life’ (EoL) (from last CT to death). OS was estimated using the Kaplan-Meier method. Costs included all hospitalizations for SCCHN, consultations, medical devices, biology and imaging procedures, supportive and palliative care, transportation, patients’ out of pocket expenses and indirect cost (daily allowances for sick leaves and disability pensions).
Among 267 patients identified, 85% were men, 44% had metastases at the index date and mean age was 62.0 years (±9.9). Most common tumor locations were oropharynx (29%), oral cavity (12%), larynx (10%) and hypopharynx (10%) but 39% of the patient had multiple locations. Median OS was 9.3 months in overall population with no significant difference between recurrent or metastatic patients (10.5 vs. 8.3 months, p = 0.092). The median OS ranged from 8.3 months for tumors located in the oro/hypopharynx to 10.9 months for those in the oral cavity. The average cost per patient was €48,069 breakdown into €31,136 [95CI: 27,935–34,336] for hospitalizations and €16,933 [14,866–19,000] for outpatient care. During CT period (209 days on average), main cost drivers were CT acquisition and administration (€13,755), home care (€2454), transportation (€1954) and physician fees (€1214). During EoL period (125 days), palliative care (€3548), home care (€977), nursing care (€711) and physician fees (€618) were the main cost drivers.
This analysis of real-world data confirms the poor prognosis in patients with R/M SCCHN and provides cost data for future economic evaluations.
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A. Lafuma, C. Le Tourneau, C. Emery, E. Torreton, J. Bonastre: Consultancy: BMS. F-E. Cotté, A-F. Gaudin: Employee: BMS. All other authors have declared no conflicts of interest.