Indirect Cost Burden Attributable to Locally Advanced Head and Neck Squamous Cell Carcinoma in the United States

Abstract

<h3>Purpose/Objective(s)</h3> Chemoradiation (CRT) is the current standard of care for unresectable locally advanced head and neck squamous cell carcinoma (LA HNSCC). However, the prognosis of LA HNSCC remains poor in patients managed by CRT alone. Limited information is available on the indirect cost burden imposed by progressions and deaths due to LA HNSCC. This study aimed to estimate the indirect costs attributable to LA HNSCC under CRT, including indirect costs due to premature death, impaired productivity while alive, and caregiver burden. <h3>Materials/Methods</h3> A partitioned survival model with four health states (event-free, locoregional recurrence/progression [LR/P], recurrent/distant metastases [R/DM], and death) was developed to track health status over time for a cohort of adult patients initiating CRT for LA HNSCC. Survival endpoints were extrapolated using exponential distributions fitted to digitized, published Kaplan-Meier data from the JAVELIN Head and Neck 100 trial. Indirect costs due to premature death were calculated based on expected life years lost relative to a general population cohort with the same baseline age (59 years) and gender (18% female). Indirect costs due to morbidity-related patient work loss and caregiver burden were assessed based on time spent in the LR/P and R/DM states and literature-based estimates of: productivity impairment by state among patients and caregivers; and proportion of patients who require caregiving by state. A human capital approach was used to calculate the present value of life years lost, productivity loss while alive, and caregiver burden over a lifetime, applying 3% discounting and 1% earnings growth annually. Under this approach, the potential annual value of productivity at each age was calculated using nationally reported labor force participation, annual labor earnings, hours of non-market labor, and a markup for employer-provided benefits. <h3>Results</h3> In patients initiating CRT for LA HNSCC, 95% were expected over their remaining lifetime to have a progression or premature death due to HNSCC, resulting in 14.1 life years lost. Lifetime indirect costs were an estimated $556,412 per patient with LA HNSCC, with indirect costs due to premature death comprising 83% of this total. <h3>Conclusion</h3> LA HNSCC is associated with substantial indirect costs over a lifetime, highlighting the need for more effective treatments that prevent disease progression and prolong survival. The indirect costing approach adopted in this study can be applied to economic evaluations of new interventions for LA HNSCC when considering a societal perspective.