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Treatment, short‐term outcomes, and costs associated with larynx cancer care in commercially insured patients
Author(s) -
Day Andrew T.,
Chang HsienYen,
Quon Harry,
Kang Hyunseok,
Kiess Ana P.,
Eisele David W.,
Frick Kevin D.,
Gourin Christine G.
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26717
Subject(s) - medicine , comorbidity , retrospective cohort study , laryngectomy , odds ratio , cancer , larynx , gastrostomy , surgery , relative risk , confidence interval
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