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Concurrent cisplatin or cetuximab with radiotherapy for HPV-positive oropharyngeal cancer: Medical resource use, costs, and quality-adjusted survival from the De-ESCALaTE HPV trial.
Eur J Cancer 2020; 124:178-185EJ

Abstract

BACKGROUND

The De-ESCALaTE HPV trial confirmed the dominance of cisplatin over cetuximab for tumour control in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Here, we present the analysis of health-related quality of life (HRQoL), resource use, and health care costs in the trial, as well as complete 2-year survival and recurrence.

MATERIALS AND METHODS

Resource use and HRQoL data were collected at intervals from the baseline to 24 months post treatment (PT). Health care costs were estimated using UK-based unit costs. Missing data were imputed. Differences in mean EQ-5D-5L utility index and adjusted cumulative quality-adjusted life years (QALYs) were compared using the Wilcoxon signed-rank test and linear regression, respectively. Mean resource usage and costs were compared through two-sample t-tests.

RESULTS

334 patients were randomised to cisplatin (n = 166) or cetuximab (n = 168). Two-year overall survival (97·5% vs 90·0%, HR: 3.268 [95% CI 1·451 to 7·359], p = 0·0251) and recurrence rates (6·4% vs 16·0%, HR: 2·67 [1·38 to 5·15]; p = 0·0024) favoured cisplatin. No significant differences in EQ-5D-5L utility scores were detected at any time point. At 24 months PT, mean difference was 0·107 QALYs in favour of cisplatin (95% CI: 0·186 to 0·029, p = 0·007) driven by the mortality difference. Health care costs were similar across all categories except the procurement cost and delivery of the systemic agent, with cetuximab significantly more expensive than cisplatin (£7779 [P < 0.001]). Consequently, total costs at 24 months PT averaged £13517 (SE: £345) per patient for cisplatin and £21064 (SE: £400) for cetuximab (mean difference £7547 [95% CI: £6512 to £8582]).

CONCLUSIONS

Cisplatin chemoradiotherapy provided more QALYs and was less costly than cetuximab bioradiotherapy, remaining standard of care for nonsurgical treatment of HPV-positive OPSCC.

Authors+Show Affiliations

Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: alastair.gray@dph.ox.ac.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31794928

Citation

Jones, David A., et al. "Concurrent Cisplatin or Cetuximab With Radiotherapy for HPV-positive Oropharyngeal Cancer: Medical Resource Use, Costs, and Quality-adjusted Survival From the De-ESCALaTE HPV Trial." European Journal of Cancer (Oxford, England : 1990), vol. 124, 2020, pp. 178-185.
Jones DA, Mistry P, Dalby M, et al. Concurrent cisplatin or cetuximab with radiotherapy for HPV-positive oropharyngeal cancer: Medical resource use, costs, and quality-adjusted survival from the De-ESCALaTE HPV trial. Eur J Cancer. 2020;124:178-185.
Jones, D. A., Mistry, P., Dalby, M., Fulton-Lieuw, T., Kong, A. H., Dunn, J., ... Gray, A. M. (2020). Concurrent cisplatin or cetuximab with radiotherapy for HPV-positive oropharyngeal cancer: Medical resource use, costs, and quality-adjusted survival from the De-ESCALaTE HPV trial. European Journal of Cancer (Oxford, England : 1990), 124, pp. 178-185. doi:10.1016/j.ejca.2019.10.025.
Jones DA, et al. Concurrent Cisplatin or Cetuximab With Radiotherapy for HPV-positive Oropharyngeal Cancer: Medical Resource Use, Costs, and Quality-adjusted Survival From the De-ESCALaTE HPV Trial. Eur J Cancer. 2020;124:178-185. PubMed PMID: 31794928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concurrent cisplatin or cetuximab with radiotherapy for HPV-positive oropharyngeal cancer: Medical resource use, costs, and quality-adjusted survival from the De-ESCALaTE HPV trial. AU - Jones,David A, AU - Mistry,Pankaj, AU - Dalby,Matthew, AU - Fulton-Lieuw,Tessa, AU - Kong,Anthony H, AU - Dunn,Janet, AU - Mehanna,Hisham M, AU - Gray,Alastair M, Y1 - 2019/11/30/ PY - 2019/08/13/received PY - 2019/10/08/revised PY - 2019/10/28/accepted PY - 2019/12/4/pubmed PY - 2019/12/4/medline PY - 2019/12/4/entrez KW - Cetuximab KW - Chemoradiotherapy KW - Cisplatin KW - Costs KW - Human papillomavirus KW - Oropharyngeal squamous cell carcinoma KW - Overall survival KW - Quality of life KW - Recurrence KW - Resource use SP - 178 EP - 185 JF - European journal of cancer (Oxford, England : 1990) JO - Eur. J. Cancer VL - 124 N2 - BACKGROUND: The De-ESCALaTE HPV trial confirmed the dominance of cisplatin over cetuximab for tumour control in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Here, we present the analysis of health-related quality of life (HRQoL), resource use, and health care costs in the trial, as well as complete 2-year survival and recurrence. MATERIALS AND METHODS: Resource use and HRQoL data were collected at intervals from the baseline to 24 months post treatment (PT). Health care costs were estimated using UK-based unit costs. Missing data were imputed. Differences in mean EQ-5D-5L utility index and adjusted cumulative quality-adjusted life years (QALYs) were compared using the Wilcoxon signed-rank test and linear regression, respectively. Mean resource usage and costs were compared through two-sample t-tests. RESULTS: 334 patients were randomised to cisplatin (n = 166) or cetuximab (n = 168). Two-year overall survival (97·5% vs 90·0%, HR: 3.268 [95% CI 1·451 to 7·359], p = 0·0251) and recurrence rates (6·4% vs 16·0%, HR: 2·67 [1·38 to 5·15]; p = 0·0024) favoured cisplatin. No significant differences in EQ-5D-5L utility scores were detected at any time point. At 24 months PT, mean difference was 0·107 QALYs in favour of cisplatin (95% CI: 0·186 to 0·029, p = 0·007) driven by the mortality difference. Health care costs were similar across all categories except the procurement cost and delivery of the systemic agent, with cetuximab significantly more expensive than cisplatin (£7779 [P < 0.001]). Consequently, total costs at 24 months PT averaged £13517 (SE: £345) per patient for cisplatin and £21064 (SE: £400) for cetuximab (mean difference £7547 [95% CI: £6512 to £8582]). CONCLUSIONS: Cisplatin chemoradiotherapy provided more QALYs and was less costly than cetuximab bioradiotherapy, remaining standard of care for nonsurgical treatment of HPV-positive OPSCC. SN - 1879-0852 UR - https://www.unboundmedicine.com/medline/citation/31794928/Concurrent_cisplatin_or_cetuximab_with_radiotherapy_for_HPV-positive_oropharyngeal_cancer:_Medical_resource_use,_costs,_and_quality-adjusted_survival_from_the_De-ESCALaTE_HPV_trial L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-8049(19)30797-X DB - PRIME DP - Unbound Medicine ER -