To compare the treatment patterns and resulting quality adjusted life year (QALY) in patients of Head & Neck cancers under private payment scheme (PPS) and government scheme (GS).
In a prospective study treatment orders of patients on chemotherapy for head & neck cancers were reviewed and patients were interviewed for six treatment cycles to assess treatment patterns in an oncology hospital having dedicated wards for patients under GS. & PPS. Direct medical cost, indirect medical cost and non-medical costs associated with treatment were calculated for patients under PPS and GS and were compared. EQ-5D-5L instrument was administered to assess patient utility with treatment during each cycle.
A total of 104 patients (n = 49 under PPS, n = 55 under GS) were enrolled in the study after obtaining their informed consent. Majority of the patients under PPS were on Paclitaxel based regimen (63%) followed by primary protocol ((Docetaxel+ Cyclophosphamide+ Fluorouracil, (8%)). Most of the patients under GS were treated with Cisplatin with radiation therapy (82%) and none of the eligible patients under GS had privilege of treatment with primary protocol due to limited budget. Treatment compliance to NCCN guidelines for patients under PPS and GS was 89% and 58% respectively. Common adverse events like vomiting, constipation, neutropenia, fatigue and myalgia were higher in patients under GS than PPS. Average cost of treatment for PPS and GS per cycle was US $125 and US $30 respectively. QALY gained by patients under PPS and GS after six cycles was 0.024 and 0.014 respectively and the difference was found to be statistically significant (p < 0.05).
Treatment patterns in patients under PPS were well compliant to NCCN guidelines. Limited budget of government scheme in a developing country does not allow clinicians to prescribe required anti-cancer medicines and supportive care. Patients under GS can be benefited with more utility with additional increment in the budget.
Clinical trial identification
All authors have declared no conflicts of interest.