338P A comparative study to evaluate treatment patterns and resulting utility in patients of head & neck cancers under private payment scheme and government scheme

Abstract

Objective/purpose: To compare the treatment patterns and resulting quality-adjusted life year (QALY) in patients of head and neck cancers under private payment scheme (PPS) and government reimbursement scheme (GRS). Study design/methods: In a prospective study, treatment orders of patients on chemotherapy for head and neck cancers were reviewed for six treatment cycles to assess treatment patterns in an oncology hospital. EQ-5D-5L instrument was administered to assess patient utility with treatment during each cycle. Results/key findings: A total of 104 patients (n=49 under PPS, n=55 under GRS) were enrolled in the study after obtaining their informed consent. Majority of the patients underPPSwere onPaclitaxel-based regimen (63%) followed by primary protocol ((Docetaxel+ Cyclophosphamide+ Fluorouracil, (8%)). Most of the patients under GRS were treated with Cisplatin with radiation therapy (82%) and none of the eligible patients underGRS had privilege of treatment with primary protocol due to restricted formulary of the scheme. Treatment compliance to NCCN guidelines for patients under PPS and GRS was 89% and 58%, respectively. Common adverse events like vomiting, constipation, neutropenia, fatigue and myalgia were higher in patients under GRS than PPS. QALY gained by patients under PPS and GRS after six cycles was 0.024 and 0.014, respectively (p<0.05). Conclusion/recommendations: Treatment patterns in patients under PPS were well compliant to NCCN guidelines. Limited budget and restricted formulary of government scheme in a developing country does not allow clinicians to prescribe required anti-cancer medicines and supportive care. Patients under GRS can be benefited with more utility with additional increment in the budget.