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

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

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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.

Original languageEnglish
Pages (from-to)178-185
Number of pages8
JournalEuropean Journal of Cancer
Volume124
Early online date30 Nov 2019
DOIs
Publication statusPublished - Jan 2020

Keywords

  • 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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