Higher-Quality Larynx Cancer Care Associated with Lower Mortality, Morbidity

Is there an association between higher-quality care, outcomes, and costs in younger, commercially insured patients with larynx cancer?

Bottom line
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 one-year costs, even after controlling for quality.

Background: Defining quality and its measurement has become a key priority for both physicians and healthcare organizations. The collection of quality data has the potential to require substantial resources and administrative support that is not reimbursed and not feasible for many practices. An ideal quality measure is evidence-based, disease-specific, integrated with the delivery of healthcare, and broadly applicable across clinical settings, and demonstrates improved outcomes and lower costs. However, limited data exists on measuring quality in head and neck cancer care. Previous reports concluded that higher-quality care was associated with improved survival and lower costs of care in elderly larynx cancer patients, and high-volume care was associated with a greater likelihood of higher-quality initial treatment. In surgical patients, high-volume care was associated with improved survival and lower costs even after controlling for quality.

Study design: Retrospective cross-sectional analysis.

Synopsis: A cross-sectional analysis of patients with a diagnosis of larynx cancer was performed using data from the MarketScan Commercial Claims and Encounters Database and the MarketScan Lab Database (Truven Health Analytics, Ann Arbor, MI). This large U.S.-based employment database contains individual-level inpatient and outpatient insurance billing claims for employees and their dependents ≥ 65 years of age from approximately 45 large employers covered by over 100 commercial payors. Investigators 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 (OR = 0.21, 95% 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 one-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]).