Cost-Effectiveness of Radiation Therapy Versus Transoral Robotic Surgery for Early-Stage Oropharyngeal Squamous Cell Carcinoma

Abstract

concurrent and induction chemo, smoking status, sex and age. Process maps were created for each clinical activity from initial consultation through one-year of follow-up. Resource costs and times were determined for each activity. A software algorithm was used to link each patient-specific clinical activity with a process map and TDABC cost over the full cycle of care. All TDABC costs for IMPT and IMRT were normalized to the lowest cost IMRT patient to allow for relative cost comparisons. Results: TDABC costs for the IMRT patients ranged from 1.00 to 3.30 times that of the lowest cost IMRT patient (mean Z 1.66, STD Z 0.56). TDABC costs for the IMPT patients ranged from 1.95 to 3.18 times that of the lowest cost IMRT patient (mean Z 2.54, STD Z 0.39). Although the daily single fraction cost of delivering IMPT was 2.79 times greater than the cost of delivering IMRT (mainly due to the higher equipment costs), the average full cycle cost of IMPTwas only 1.53 times higher than IMRT. Interestingly, seven (28%) IMRT patients had costs that overlapped or were greater than IMPT costs. This subset of IMRT patients required more intensive resources, such as feeding tube, hospitalization, or other supportive measures. Conclusion: As advanced technology meets patient care, TDABC is the vital first step in measuring true provider costs of radiation therapy. Although IMPT is on average more costly than IMRT due to higher equipment expenses, there is a subset of IMRT patients who are more costly than IMPT patients, due to higher resource utilization caused by toxicity. Providers will need to coordinate analyses of multi-dimensional patient outcomes and TDABC costs to define the value of all radiation therapy modalities. As insurers move towards bundled payments, TDABC costs will be vital in negotiating contracts, undergoing process improvement, and ensuring equitable and rational patient access to advanced technologies. Author Disclosure: N.G. Thaker: None. A. Agarwal: None. T.M. Jones: None. A.B. Guzman: None. T.W. Feeley: None. G.B. Gunn: None. A.S. Garden: None. M. Palmer: None. T.A. Buchholz: None. S.J. Frank: Board member; American Brachytherapy Society.