Christopher J. Britt, Harry Quon, Hsien-Yen Chang, Kevin D. Frick, Hyunseok Kang, David W. Eisele, Christine G. Gourin, Ana P. Kiess
To examine associations between quality, complications, and costs in commercially insured patients treated for laryngeal cancer.
Retrospective cross-sectional analysis of MarketScan Commercial Claim and Encounters data (Truven Health Analytics, Ann Arbor, Michigan, U.S.A.).
We evaluated 10,969 patients diagnosed with laryngeal cancer from 2010 to 2012 using cross-tabulations and multivariate regression. Using quality indicators derived from guidelines for recommended care, summary measures of quality were calculated for diagnosis, initial treatment, surveillance, treatment for recurrence, performance, and an overall summary measure of quality.
Higher-quality care in the initial treatment period was associated with lower odds of 30-day mortality (odds ratio [OR] = 0.21, 95% confidence interval [CI] [0.04–0.98]), surgical complications (OR = 0.39 [0.17–0.88]), and medical complications (OR = 0.68 [0.49–0.96]). Mean incremental 1-year costs were higher for higher-quality diagnosis ($20,126 [$14,785–$25,466]), initial treatment ($17,918 [$10,481–$25,355]), and surveillance ($25,424 [$20,014–$30,834]) quality indicators, whereas costs were lower for higher-quality performance measures (−$45,723 [−$56,246–−$35,199]) after controlling for all other variables. Higher-quality care was associated with significant differences in mean incremental costs for initial treatment in surgical patients ($−37,303 [−$68,832–−$5,775]), and for the overall summary measure of quality in patients treated nonoperatively ($10,473 [$1,121–$19,825]). After controlling for the overall summary measure of quality, costs were significantly lower for patients receiving high-volume surgical care (mean −$18,953 [−$28,381–−$9,426]).
Higher-quality larynx cancer care in commercially insured patients was associated with lower 30-day mortality and morbidity. High-volume surgical care was associated with lower 1-year costs, even after controlling for quality. These data have implications for discussions of value and quality in an era of healthcare reform.
Level of Evidence
2c. Laryngoscope, 127:2805–2812, 2017