Treatment, short-term outcomes, and costs associated with larynx cancer care in commercially insured patients

Andrew T. Day, Hsien Yen Chang, Harry Quon, Hyunseok Kang, Ana P. Kiess, David W. Eisele, Kevin D. Frick, Christine G. Gourin

Research output: Contribution to journalArticle

Abstract

Objectives/Hypothesis: To examine associations between treatment, complications, and costs in patients with laryngeal cancer. Study Design: Retrospective cross-sectional analysis of MarketScan Commercial Claim and Encounters data. Methods: We evaluated 10,969 patients diagnosed with laryngeal cancer from 2010 to 2012 using cross-tabulations and multivariate regression. Results: Chemoradiation was significantly associated with supraglottic tumors (relative risk ratio [RRR] = 5.9 [4.4–7.8]), pretreatment gastrostomy (RRR = 4.0 [2.7–6.1]), and alcohol abuse (RRR = 0.5 [0.3–0.9]). Treatment-related complications occurred in 23% of patients, with medical complications in 22% and surgical complications in 7%. Chemoradiation (odds ratio [OR] = 3.7 [2.6–5.2]), major surgical procedures (OR = 4.9 [3.5–6.8]), reconstruction (OR = 7.7 (4.1–14.7)], and advanced comorbidity (OR = 9.7 [5.7–16.5] were associated with acute complications. Recurrent/persistent disease occurred in 23% of patients and was associated with high-volume care (OR = 1.4 [1.1–1.8]). Salvage surgery was performed in 46% of patients with recurrent/persistent disease and was less likely for supraglottic disease (OR = 0.5 [0.4–0.8]) and after chemoradiation (OR = 0.4 [0.2–0.6]). Initial treatment and 1-year overall costs for chemoradiation were higher than all other treatment categories, after controlling for all other variables including complications and salvage. High-volume care was associated with significantly lower costs of care for surgical patients but was not associated with differences in costs of care for nonoperative treatment. Conclusions: In commercially insured patients <65 years old with laryngeal cancer, chemoradiation was associated with increased costs, an increased likelihood of treatment-related medical complications, and a reduced likelihood of surgical salvage. Higher-volume surgical care was associated with lower initial treatment and 1-year costs of care. These data have implications for discussions of value and quality in an era of healthcare reform. Level of Evidence: 2c. Laryngoscope, 128:91–101, 2018.

Original languageEnglish (US)
Pages (from-to)91-101
Number of pages11
JournalLaryngoscope
Volume128
Issue number1
DOIs
StatePublished - Jan 1 2018

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Keywords

  • chemotherapy
  • costs
  • Laryngeal neoplasms
  • MarketScan
  • radiation
  • squamous cell cancer
  • surgery
  • treatment

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Day, A. T., Chang, H. Y., Quon, H., Kang, H., Kiess, A. P., Eisele, D. W., Frick, K. D., & Gourin, C. G. (2018). Treatment, short-term outcomes, and costs associated with larynx cancer care in commercially insured patients. Laryngoscope, 128(1), 91-101. https://doi.org/10.1002/lary.26717