Table III.
Current protective treatments
| Protecting the salivary glands |
IMRT | Amifostine | Salivary gland transfer |
|---|---|---|---|
| % Patients still experiencing xerostomia post-RT |
25%–40%8,40 | 51%41 | ~20%42 |
| Treatment planning time | 15–26 h43 | None | None |
| Treatment delivery time | 15–30 min44 per session, in 35 sessions over 7 weeks | None | 45 min45 |
| Cost calculation | 2006 MP for whole breast IMRT = $29,79046 2010 MP for prostate cancer IMRT = $42K47 2011 MP for: IMRT planning, (CPT code 77301), $2088.19 þ IMRT delivery (CPT code 77418), $519.84 per treatment session × 35 sessions = $20,282.5948 |
Calculated assuming the patients gets 8 mg of odansetron (anti-nausea drug) before each of 35 subcutaneous injections of 500 mg amifostine, before each RT session, over a 7-week period. 2011 MP for: odansetron (HCPCS code Q1079), $0.676 × 35 sessions + amifostine (HCPCS code J0207), $322.019 × 35 sessions = $11,30049 |
2010 MP for “unlisted procedure, salivary glands or ducts” (CPT code: 42699), $1335 (RVU = 0)*; 2010 MP for “excision of submandibular glands” (CPT code: 42440), $1725 (RVU = 7.13)* |
| Cost estimate per treatment course |
$20-$100K | $10-$30K | $10-$20K |
| Invasiveness | None | None | High |
| Contraindications | None | Allergies to aminothiol compounds | Oral cavity malignancies requiring RT to submental area + any H&N cancer not requiring surgical resection |
| Side effects | None | Nausea, vomiting, hypotension | None |
| Protecting the salivary glands | BoNT (emerging treatment option) | IGF-1 growth factor (emerging treatment option) |
|---|---|---|
| % Patients still experiencing xerostomia post-RT |
N/A. Preclinical stage | N/A. Preclinical stage |
| Treatment Planning time | None | None |
| Treatment delivery time | 1 min | 1 min |
| Cost calculation | Less than 20 U of BoNT per patient will be necessary and up to 100 U per bottle may be charged if 1 bottle is used for only 1 patient, amounting the cost of the drug to $125-$600 (BoNT type A, HCPCS code: J0585, $5.48/U).49,50 Treatment delivered in a single injection, estimated to $200, based on CPT codes for a similar procedure (CPT code 64613 for injection of BoNT to the neck to treat muscular pain, is $164.11 in non-facility setting),48,50 |
Based on an FDA-approved daily dose of 0.24 mg/kg, adapted to a 70 kg adult and an average 2006 wholesale price of $562.50 per vial of 40 mg Increlex,51 the annual cost of an IGF-1 treatment for xerostomia can be expected to be in the $100K range |
| Cost estimate per treatment course | $325-$800 | $100K |
| Invasiveness | None | None |
| Contraindications | None | Unknown |
| Side effects | None | N/A |
The current treatments aimed at protecting the salivary glands are summarized. For each treatment, details are provided about the following parameters: xerostomia rate after RT, treatment planning duration, treatment delivery duration, cost estimate per treatment course, with detailed cost calculation, invasiveness, contraindications, and side-effects.
MP, medicare payment; RVU, relative value unit; N/A, not available.
*
2010 Otolaryngology fee schedule.