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

Pankaj Mistry, Matthew Dalby, Tessa Fulton-Lieuw, Anthony Kong, Janet Dunn, Hisham Mehanna, Alastair Gray, David A Jones

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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.

Original languageEnglish
Pages (from-to)178-185
Number of pages8
JournalEuropean Journal of Cancer
Early online date30 Nov 2019
Publication statusPublished - Jan 2020

Bibliographical note

Funding Information:
This study was supported by Cancer Research UK [grant number C19677/A12834 ]. AG is partly supported by the NIHR Biomedical Research Centre , Oxford.

Funding Information:
Hisham Mehanna reports personal fees from Warwickshire Head Neck Clinic Ltd, AstraZeneca, MSD, Sanofi Pasteur, and Merck; grants from GlaxoSmithKline Biologicals, MSD, Sanofi Pasteur, Silence Therapeutics, GlaxoSmithKline, AstraZeneca, and several academic funders including the National Institute for Health Research (NIHR) Health Technology Assessment Unit, Cancer Research UK, and the Medical Research Council; and travel expenses from Sanofi Pasteur, MSD, and Merck, outside the submitted work. All other authors declare no conflict of interests. Appendix A

Publisher Copyright:
© 2019 The Authors


  • oropharyngeal squamous cell carcinoma
  • human papillomavirus
  • chemoradiotherapy
  • cisplatin
  • cetuximab
  • Overall survival
  • recurrence
  • resource use
  • costs
  • quality of life
  • Recurrence
  • Costs
  • Oropharyngeal squamous cell carcinoma
  • Chemoradiotherapy
  • Cisplatin
  • Quality of life
  • Human papillomavirus
  • Cetuximab
  • Resource use
  • Cetuximab/economics
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Male
  • Papillomaviridae/isolation & purification
  • Papillomavirus Infections/economics
  • Female
  • Oropharyngeal Neoplasms/economics
  • Cisplatin/economics
  • Neoplasm Recurrence, Local/blood
  • Quality-Adjusted Life Years
  • Standard of Care
  • United Kingdom
  • Squamous Cell Carcinoma of Head and Neck/economics
  • Health Care Costs/statistics & numerical data
  • Quality of Life
  • Health Resources/economics
  • Aged
  • Chemoradiotherapy/economics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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