Table 5. Summary of costs estimates of included studies in the systematic review.
| Study | Year of cost | Country | Currency | Cancer anatomical sites considered for cost | Cost per patient (95% CI) | Cost per patient by clinical stage | Other measures of cost (95% CI) |
|---|---|---|---|---|---|---|---|
| Longitudinal studies | |||||||
| 1. Kim, 2011 [23] | 2009 | United Kingdom | Pounds (GBP) | Lip; other and unspecified parts of tongue; oral cavity; pharynx; larynx | Post-operative treatment for resected patients (average)– 5-year follow-up: • Lip: 5,790 • Tongue: 19,493 • Oral cavity: 25,311 |
Not applicable | Post-operative treatment for resected patients (average)– 5-year follow-up: Inpatient care: • Lip: 4,798 • Tongue: 17,910 • Oral cavity: 23,143 Outpatient care: • Lip: 992 • Tongue: 1,583 • Oral cavity: 2,168 |
| 2. Polesel, 2019 [26] | 2010 | Italy | Euros (EUR) | Oral cavity (including lip and pharynx); oropharynx; hypopharynx; larynx | Cost per patient (average– 95% CI)– 2-year follow-up: • Oral cavity: 18,462 (17,720–19,205) • Oropharynx: 24,253 (23,197–25,310) |
Not applicable | Cost per patient (average– 95%CI): Oral cavity: • Before treatment: 1,223 (1,103–1,343) • 0–3 months treatment: 11,102 (10,702–11,503) • 4–12 months treatment: 4,421 (3,838–5,004) • 13–24 months treatment: 2,282 (2,071–2,493) Oropharynx: • Before treatment: 2,932 (2,640–3,223) • 0–3 months treatment: 12,646 (12,123–13,170) • 4–12 months treatment: 8,658 (7,562–9,754) • 13–24 months treatment: 4,113 (3,696–4,531) |
| 3. Jacobson, 2012 [24] | 2009 | United States of America | US Dollars (USD) | Lip; base of tongue; gum; floor of mouth; other and unspecified parts of mouth; oral cavity; salivary gland; major salivary gland; oropharynx | Not reported | Not applicable | Oral cavity, oropharynx and salivary gland tumors (average ± standard deviation)– 1-year follow-up: • Commercial insurance: 79,151 ± 86,170 • Medicare: 48,410 ± 61,599 • Medicaid: 59,404 ± 74,919 |
| 4. Pollaers, 2019 [25] | 2016/2017 | Australia | Australian Dollars (AUD) | Other and unspecified parts of tongue; floor of mouth; retromolar trigone | Squamous cell carcinoma (average)– 2-year follow-up: Floor of mouth: 103,832 • First year: 101,187 • Second year: 2,645 Tongue: 92,761 • First year: 86,391 • Second year: 6,279 |
Inpatients costs: Stage I: • 1-year: 33,985 • 2-year: 37,101 • 5-year: 43,661 Stage II: • 1-year: 61,690 • 2-year: 45,376 • 5-year: 44,548 Stage III: • 1-year: 79,684 • 2-year: 90,557 • 5-year: 88,976 Stage IVa: • 1-year: 93,269 • 2-year: 104,257 • 5-year: 118,913 |
Squamous cell carcinoma of floor of the mouth, tongue, and alveolar trigone (average)– 2‐year follow‐up: • Remained disease‐free: 65,012 • Cases with disease recurrence: 98,359 First year: • Inpatient: 66,004 • Outpatient: 30,214 Second year: • Inpatient: 72,208 • Outpatient: 35,590 |
| 5. Huang, 2020 [27] | 2018 | Taiwan | US Dollars (USD) | Lip; base of tongue; other and unspecified parts of tongue; gum; floor of mouth; palate; other and unspecified parts of mouth; tonsil; oropharynx; piriform sinus; hypopharynx; ill-defined and unspecified sites of lips, oral cavity, and pharynx | Average per patient– 2.3-years follow-up: 56,501 Mean ± standard deviation: • Direct medical costs mean: 19,644 ± 15,305 • Indirect costs morbidity: 1,286 ± 1,386 • Indirect costs mortality: 35,570 ± 61,859 • All medication costs mean: 2,359 • Anticancer drug costs mean: 638 |
--- | --- |
| Cross-sectional and case control studies | |||||||
| 6. Rezapour, 2018 [29] | 2014 | Iran | US Dollars (USD) | Lip; other and unspecified parts of tongue; floor of mouth; buccal | Floor of mouth, lip, tongue, buccal (average)– 1-year follow-up: Direct costs: • Diagnosis: 82 • Early stage (I/II): 2,225 • Advanced stage (III/IV): 10,532 • Recurrency: 1,485 • Follow-up: 291 Direct non-medical costs • Traveling: 1,035 • Home care: 665 Indirect costs: • Employed patients: 2,477 • Unemployed patients: 1,230 • Accompanied: 481 • Premature mortality: 106,257 |
Floor of mouth, lip, tongue, buccal (average)– 1-year follow-up: • Stages I/II (surgery and radiotherapy): 2,225 • Stages III/IV (surgery, radiotherapy, and chemotherapy): 10,532 |
Total cost (Iran): 64,245,173 Direct costs: 27,284,501 • Direct non-medical costs: 5,143,629 • Indirect costs: 31,817,043 |
| 7. van Agthoven, 2001 [35] | 1996 | The Netherlands | Euros (EUR) | Oral cavity; oropharynx; larynx | Average per patient– 10-year follow-up: • Oral cavity: 35,541 • Oropharynx: 35,642 |
Not applicable | Oral cavity (per patient): • Primary tumor: 25,425 • Recurrent tumor: 25,543 Oropharynx (per patient): • Primary tumor: 25,679 • Recurrent tumor: 25,145 |
| 8. Fisher, 2018 [36] | 2016 | United States of America | US Dollars (USD) | Oral cavity; oropharynx; hypopharynx/larynx; salivary glands; nasopharynx; other/unknown | Not reported | Not applicable | Monthly health care costs (average ± standard deviation): Total costs: 14,391 ± 19,510 • Hospitalization: 8,136 ± 16,880 • Emergency visits: 433 ± 1,259 • Office visits: 123 ± 109 • Systemic anticancer therapy: 2,875 ± 5,259 • Medical oncology procedures: 2,415 ± 6,962 • Infused supportive care drugs: 232 ± 479 All other drugs delivered: 178 ± 242 |
| 9. Nijdam, 2005 [32] | 2001 | The Netherlands | Euros (EUD) | Oropharynx | Oropharynx (average): • BT group*: 18,001 • S group*: 28,130 • EBRT group*: 21,143 |
Not applicable | Not available |
| 10. Amarasinghe, 2019 [18] | 2016 | Sri Lanka | US Dollars (USD) | Lip; other and unspecified parts of tongue; floor of mouth; palate; other and unspecified parts of mouth | Lip, tongue, and mouth (average)– 1-year follow-up: Stage II: System cost: • Recurrent costs: 381 • Capital cost: 13 Household: • Direct costs: 256 • Indirect costs: 263 Stage III and IV: System cost: • Recurrent costs: 2,011 • Capital cost: 13 Household: • Direct costs: 217 • Indirect costs: 263 |
Lip, tongue, and mouth per patient (average)– 1-year follow-up: • Stage II: 912 • Stage III/IV: 2,507 |
Not available |
| 11. Goyal, 2014 [33] | 2011/2012 | India | Rupees (INR) | Lip; other and unspecified parts of tongue; floor of mouth; buccal mucosa; retromolar trigone | Hospitalization (average ± standard deviation): 1,46,092 ± 37,325 | Hospitalization (average): • Stage I: 1,49,995 • Stage II: 1,41,621 • Stage III: 1,82,859 |
Not available |
| 12. Zavras, 2002 [37] | 2001 | Greece | US Dollars (USD) | Upper lip, inner aspect; lower lip, inner aspect; lip, unspecified, inner aspect; commissure of lip; overlapping lesion of lip; lip, unspecified; base of tongue; other and unspecified parts of tongue; gum; floor of mouth; palate; other and unspecified parts of mouth | Average per patient: 7,450 | Average: • Stage I: 3,662 • Stage II: 5,867 • Stage III: 10,316 • Stage IV: 11,467 |
Not available |
| 13. van der Linden, 2016 [38] | 2013 | The Netherlands | Euros (EUR) | Oral cavity; oropharynx; hypopharynx; nasopharynx; larynx | Not reported | Not applicable | Cost per treatment group (average ± standard deviation): • Cisplatin + 5-fluorouracil + cetuximab: 39,459 ± 21,149 • Other platinum-based combination therapy: 38,584 ± 26,065 • Methotrexate monotherapy: 10,075 ± 9,891 • Capecitabine monotherapy: 10,585 ± 14,544 • Other: 17,506 ± 16,634 |
| 14. Epstein, 2008 [34] | 2002 | United States of America | US Dollars (USD) | Lip; other and unspecified parts of tongue; gum; floor of mouth; other and unspecified parts of mouth; oropharynx; pharynx; nasopharynx; hypopharynx; Waldeyer’s ring | Oral and pharyngeal squamous cell carcinoma (median– 95%CI)– 1-year follow-up: 25,319 (21,825–27,665) | Oral and pharyngeal squamous cell carcinoma (median): • No treatment 9,763 (IR: 3,520–24,439) • Early-stage treatment: 22,658 (IR: 10,425–42,664) • Late-stage treatment: 27,665 (IR: 19,335–52,547) |
Not available |
| 15. Lafuma, 2019 [30] | 2018 | France | Euros (EUR) | Base of tongue; gum; floor of mouth; palate; tonsil; oropharynx; nasopharynx; piriform sinus; hypopharynx; larynx | Not reported | Not applicable | Squamous cell carcinomas of the head and neck (average– 95%CI): Total costs: 52,943 Direct costs: 49,954 • Ambulatory care: 17,047 (14,941–19,152) • Inpatient care 32,908 (29,525–36,290) • Public hospitals: 26,015 (22,716–29,314) • Private for-profit hospitals: 6,892 (4,809–8,976) Indirect costs: 2,989 • Disability: 1,397 (624–2,171) • Sick leave: 1,592 (888–2,297) |
| 16. Patterson, 2020 [31] | 2017 | Global, stratified by region and income | Purchasing Power Parity (PPP) | Lip; palate; base of tongue; other and unspecified parts of tongue; gum; floor of mouth; oral cavity; other and unspecified parts of mouth; tonsil; oropharynx; other pharynx; nasopharynx; larynx; thyroid | Not reported | Not applicable | Projected global cumulative loss of 535 billion US dollars in economic output due to head and neck cancer between 2018 and 2030. Southeast Asia, East Asia, and Oceania will suffer the greatest GDP losses at 180 billion US Dollars, and South Asia will lose 133 billion US Dollars |
| 17. Han, 2010 [39] | 2007 | China | Chinese Yuans (CNY) | Lip; other and unspecified parts of tongue; floor of mouth; palate; oral cavity; buccal mucosa; gingival tissues; retromolar trigon | Squamous cell carcinoma (average ± standard deviation): 27,890 ± 11,032 | Not applicable | Squamous cell carcinoma (average ± standard deviation): • Diagnosis: 3,465 ± 1,059 • Treatment: 19,995 ± 9,701 • Hospitalization: 4,429 ± 1,618 |
| 18. Enomoto, 2015 [40] | 2009 | United States of America | US Dollars (USD) | Lip; base of tongue; other and unspecified parts of tongue; gum; floor of mouth; tonsil; oropharynx; salivary gland; nasopharynx; hypopharynx | Not reported | Not applicable | Cost per patient ≤ 30 days before death (average): Oral cavity: • Hospice: 7,880 • Non hospice: 14,990 Oropharynx: • Hospice: 8,790 • Non hospice: 16,390 |
| 19. Lairson, 2017 [41] | 2015 | United States of America | US Dollars (USD) | Base of tongue; soft palate; uvula; lingual tonsil; oropharynx; pharynx otherwise unspecified | Oropharynx: 134,454 ± 108,635 | Not applicable | Cost per patient (average ± standard deviation) - 2-year follow-up: Oropharynx: • Inpatient: 24,341 ± 48,972 • Outpatient: 106,604 ± 82,221 • Outpatient prescription drugs: 3,550 ± 5,183 • Surgery: 8,320 ± 15,111 • Radiotherapy: 50,362 ± 28,928 • Chemotherapy: 3,277 ± 2,822 |
| 20. Kim, 2020 [19] | 2015 | Korea | US Dollars (USD) | Lip; base of tongue; other and unspecified parts of tongue; gum; floor of mouth; palate; other and unspecified parts of mouth; tonsil; oropharynx; piriform sinus; hypopharynx; ill-defined and unspecified sites of lips, oral cavity, and pharynx | *Average per patient: 20,107 | --- | Total cost: 1,248 billion • Male: 1,057 billion • Female: 190,9 million |
| Cross-sectional studies based on information system data | |||||||
| 21. Vatanasapt 2012 [20] | 2010 | Thailand | Baths (THB) | Other and unspecified parts of mouth; oral cavity; oropharynx; nasopharynx; hypopharynx; pharynx; larynx; parathyroid gland; eternal and middle ear; malignant melanoma; non-melanoma skin cancer; benign neoplasms | Average per hospitalization (95%CI): • Oral cavity: 29,531 (28,316–30,745) • Oropharynx: 26,331 (23,995–28,668) • Ill-defined sites in oral cavity and pharynx: 19,356 (14,621–24,090) |
Not applicable | Total cost of hospitalization: • Oral cavity: 191,685,473 (n = 6,491) • Oropharynx: 37,258,803 (n = 1,415) • Ill-defined sites in oral cavity and pharynx: 3,135,667 (n = 162) |
| 22. Klussmann, 2013 [28] | 2008 | Germany | Euros (EUR) | Base of tongue; other and unspecified parts of tongue; gum; floor of mouth; palate; other and unspecified parts of mouth; oral cavity; tonsil; oropharynx; pharynx; nasopharynx; larynx |
* Average per hospitalization: Oral cavity: Direct costs: • Hospitalization: 6,482 • Inpatient rehabilitation: 2,713 Indirect costs: • Sick leave: 3,669 Oropharynx: Direct costs: • Hospitalization: 4,• 268 Inpatient rehabilitation: 2,705 Indirect costs: • Sick leave: 3,263 |
Not applicable |
*Total cost: Oral cavity: 131,019,446 • Direct costs: 113,268,892 ○ Hospitalization: 109,503,702 ○ Inpatient rehabilitation: 3,765,190 • Indirect costs: 17,750,554 ○ Sick leave: 17,750,554 Oropharynx: 99,404,580 • Direct costs: 83,029,501 ○ Hospitalization: 78,983,397 ○ Inpatient rehabilitation: 4,046,104 • Indirect costs: 16,375,079 ○ Sick leave: 16,375,079 |
| 23. Keeping, 2018 [21] | 2011 | England | Pounds (GBP) | Lip; base of tongue; other and unspecified parts of tongue; gum; floor of mouth; palate; oral cavity; other and unspecified parts of mouth; tonsil; oropharynx; larynx | Not applicable | Not applicable | Total cost– 5 years: Oral cavity: 98,330,746 • Inpatient: 94,876,001 • Outpatient: 3,454,745 Oropharynx: 114,619,227 • Inpatient: 108,738,446 • Outpatient: 5,880,781 |
| 24. Milani, 2021 [22] | 2018 | Brazil | International Dollar (I$) | Lip, base of tongue, other and unspecified parts of tongue, gum floor of mouth, palate, other and unspecified parts of mouth, tonsil, and oropharynx |
* Average per hospitalization: 1,376 • Lip: 655 • Oral cavity: 1,640 • Oropharynx: 1,338 |
Not applicable | Total cost– 9 years: 495.6 million • Inpatient: 244.0 million ○ Professional: 117.9 million ○ Hospital service: 92.5 million ○ Intensive care unit:33.6 million • Outpatient: 251.6 million Lip: 22.7 million • Inpatient: 18.1 million ○ Professional: 9.2 million ○ Hospital service: 7.9 million ○ Intensive care unit: 1.0 million • Outpatient: 4.6 million Oral cavity: 257.1 million • Inpatient: 139.1 million ○ Professional: 69.6 million ○ Hospital service: 55.2 million ○ Intensive care unit: 14.3 million • Outpatient: 118.0 million Oropharynx: 215.8 million • Inpatient: 86.8 million ○ Professional: 39.1 million ○ Hospital service: 29.4 million ○ Intensive care unit: 18.3 million • Outpatient: 129.0 million |
US, United States; GDP, Gross Domestic Product; 95% CI, 95% Confidence Interval; BT group, Brachytherapy group; S group, Surgery group; EBRT group, External beam radiotherapy group; IR, interquartile ranges 25%-75%; NR, Non reported; NA, Not applicable.
* Average cost estimate per event and total cost calculated by the authors of the present study according to the data reported for both sees.