Costs of treatment intensification for head and neck cancer: Concomitant chemoradiation randomised for radioprotection with amifostine

Abstract 

This study presents an overview of costs of a chemoradiation protocol in head and neck cancer patients and an analysis of whether prevention of acute toxicity with amifostine results in a reduction to costs. Fifty-four patients treated with weekly paclitaxel concomitant with radiation were randomised for treatment with subcutaneously administered amifostine (500mg) and analysed with respect to costs of treatment. Total costs for work-up, treatment and toxicity were calculated per treatment arm.

No significant differences were found between treatment arms in preliminary results regarding response (98%), toxicity and 2-year survival (77%). Average costs for toxicity were € 3.789, largely influenced by hospital admissions (€ 3.013). Total costs for amifostine administration amounted to € 6.495 per patient. The average total costs of treatment were € 19.647 versus € 13.592 with or without amifostine, respectively.

The applied (subcutaneous) dose of amifostine appeared to be insufficient for radioprotection and reduction of related costs in the concomitant chemoradiation scheme, whereas total costs increased remarkably. Although it would be accompanied by a further cost raise, applying a higher amifostine dose might reduce (mucosal) toxicity and therefore in the long run lower related costs for hospital admission and tube feeding.

Keywords: Chemotherapy, Radiotherapy, Chemoradiation, Costs, Radioprotection, Amifostine, Head and neck cancer