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 Jan:124:178-185. doi: 10.1016/j.ejca.2019.10.025. Epub 2019 Nov 30.

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.

Keywords: Cetuximab; Chemoradiotherapy; Cisplatin; Costs; Human papillomavirus; Oropharyngeal squamous cell carcinoma; Overall survival; Quality of life; Recurrence; Resource use.

Publication types

  • Clinical Trial, Phase III
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cetuximab / economics
  • Cetuximab / therapeutic use*
  • Chemoradiotherapy / economics
  • Chemoradiotherapy / methods*
  • Chemoradiotherapy / standards
  • Chemoradiotherapy / statistics & numerical data
  • Cisplatin / economics
  • Cisplatin / therapeutic use*
  • Female
  • Follow-Up Studies
  • Health Care Costs / statistics & numerical data
  • Health Resources / economics
  • Health Resources / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / blood
  • Neoplasm Recurrence, Local / economics
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm Recurrence, Local / prevention & control
  • Oropharyngeal Neoplasms / economics
  • Oropharyngeal Neoplasms / mortality
  • Oropharyngeal Neoplasms / therapy*
  • Oropharyngeal Neoplasms / virology
  • Papillomaviridae / isolation & purification
  • Papillomavirus Infections / economics
  • Papillomavirus Infections / mortality
  • Papillomavirus Infections / therapy*
  • Papillomavirus Infections / virology
  • Quality of Life
  • Quality-Adjusted Life Years
  • Squamous Cell Carcinoma of Head and Neck / economics
  • Squamous Cell Carcinoma of Head and Neck / mortality
  • Squamous Cell Carcinoma of Head and Neck / therapy*
  • Squamous Cell Carcinoma of Head and Neck / virology
  • Standard of Care
  • United Kingdom

Substances

  • Cetuximab
  • Cisplatin