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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
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Jones, David A., Mistry, Pankaj, Dalby, Matthew, Fulton-Lieuw, Tessa, Kong, Anthony H., Dunn, Janet A., Mehanna, Hisham M. and Gray, Alastair 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 Care, 124 . pp. 178-185. doi:10.1016/j.ejca.2019.10.025
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WRAP-concurrent-cisplatin-cetuximab-oropharyngeal-survival-trial-Dalby-2019.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (539Kb) | Preview |
Official URL: http://dx.doi.org/10.1016/j.ejca.2019.10.025
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.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Throat -- Cancer, Papillomaviruses, Papillomavirus diseases, Cancer -- Chemotherapy | |||||||||
| Journal or Publication Title: | European Journal of Cancer Care | |||||||||
| Publisher: | Wiley-Blackwell Publishing Ltd. | |||||||||
| ISSN: | 0961-5423 | |||||||||
| Official Date: | January 2020 | |||||||||
| Dates: |
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| Volume: | 124 | |||||||||
| Page Range: | pp. 178-185 | |||||||||
| DOI: | 10.1016/j.ejca.2019.10.025 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||
| RIOXX Funder/Project Grant: |
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