LARYNGEAL-CANCER - QUALITY-OF-LIFE LAND COST-EFFECTIVENESS

Background. The need to account for the cost of care is being imposed on clinicians by the corporate purchasers of health care. The cost-eff ectiveness of treatment for laryngeal cancer should be based on measur able and relevant clinical outcomes. Quality-of-life (QL) is a very im portant outcome, especially ii survival is similar between two treatme nts. Methods. Using QL data gathered prospectively from a group of 46 patients with glottic cancer, the effects of radiotherapy (RT) are com pared with those of surgery (total laryngectomy). Results. Surgery res ults in greater measurable dysfunction, especially of speech, but with respect to psychological functioning and general well-being, there ar e no major QL differences between patients treated surgically and thos e receiving RT. Conclusions. Cost-effectiveness of surgery, from the p erspective of patient-based QL outcome, is very similar to that for RT in advanced cancer of the larynx. Each center needs to carefully cons ider its outcomes and overall average costs per patient before decidin g which treatment regimen is to be preferred. These results have impli cations for the organ-sparing regimens in the treatment of advanced la ryngeal cancer. (C) 1997 John Wiley & Sons, Inc.