Institutional financial toxicity of failure to adhere to treatment guidelines for head and neck squamous cell carcinoma
James M. Jurica BS
School of Medicine, Baylor College of Medicine, Houston, Texas, USA
Search for more papers by this authorFelixnando Rubio BSA
School of Medicine, Baylor College of Medicine, Houston, Texas, USA
Search for more papers by this authorDavid J. Hernandez MD
ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
Search for more papers by this authorCorresponding Author
Vlad C. Sandulache MD, PhD
ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
Correspondence
Vlad C. Sandulache, Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, One Baylor Plaza, MS: NA102, Houston, TX 77030, USA.
Email: [email protected]
Search for more papers by this authorJames M. Jurica BS
School of Medicine, Baylor College of Medicine, Houston, Texas, USA
Search for more papers by this authorFelixnando Rubio BSA
School of Medicine, Baylor College of Medicine, Houston, Texas, USA
Search for more papers by this authorDavid J. Hernandez MD
ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
Search for more papers by this authorCorresponding Author
Vlad C. Sandulache MD, PhD
ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
Correspondence
Vlad C. Sandulache, Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, One Baylor Plaza, MS: NA102, Houston, TX 77030, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Delays in treatment of head and neck squamous cell carcinoma (HNSCC) are known to increase disease recurrence, generating the need for additional salvage treatment, often with immunotherapy.
Methods
Three treatment metrics were identified: time from diagnosis to treatment initiation (TTI), time from surgery to postoperative radiotherapy (surg → PORT), and total treatment package time (TPT). Financial toxicity was calculated using hazard ratios, pembrolizumab cost, and dosing data for a Veterans Health Administration (VHA) institutional cohort (n = 338) and a standardized cohort (n = 100).
Results
Estimated financial toxicity for the VHA cohort was $2 047 407, $316 545, and $1 114 101 for TTI, surg → PORT, and TPT, respectively. Estimated financial toxicity for the standardized patient cohort was $454 028, $544 576, and $1 879 628 for TTI, surg → PORT, and TPT, respectively.
Conclusions
Failure to meet established HNSCC treatment metrics generates significant, yet avoidable, institutional financial toxicity which is particularly relevant to integrated single-payer systems such as the VHA in the modern immunotherapy era.
CONFLICT OF INTEREST
The authors declare no potential conflict of interest.
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