{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T18:39:51Z","timestamp":1760985591113,"version":"3.37.3"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,7,7]],"date-time":"2017-07-07T00:00:00Z","timestamp":1499385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To examine associations between treatment, complications, and costs in patients with laryngeal cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cross\u2010sectional analysis of MarketScan Commercial Claim and Encounters data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated 10,969 patients diagnosed with laryngeal cancer from 2010 to 2012 using cross\u2010tabulations and multivariate regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Chemoradiation was significantly associated with supraglottic tumors (relative risk ratio [RRR] = 5.9 [4.4\u20137.8]), pretreatment gastrostomy (RRR = 4.0 [2.7\u20136.1]), and alcohol abuse (RRR = 0.5 [0.3\u20130.9]). Treatment\u2010related complications occurred in 23% of patients, with medical complications in 22% and surgical complications in 7%. Chemoradiation (odds ratio [OR] = 3.7 [2.6\u20135.2]), major surgical procedures (OR = 4.9 [3.5\u20136.8]), reconstruction (OR = 7.7 (4.1\u201314.7)], and advanced comorbidity (OR = 9.7 [5.7\u201316.5] were associated with acute complications. Recurrent\/persistent disease occurred in 23% of patients and was associated with high\u2010volume care (OR = 1.4 [1.1\u20131.8]). Salvage surgery was performed in 46% of patients with recurrent\/persistent disease and was less likely for supraglottic disease (OR = 0.5 [0.4\u20130.8]) and after chemoradiation (OR = 0.4 [0.2\u20130.6]). Initial treatment and 1\u2010year overall costs for chemoradiation were higher than all other treatment categories, after controlling for all other variables including complications and salvage. High\u2010volume care was associated with significantly lower costs of care for surgical patients but was not associated with differences in costs of care for nonoperative treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In commercially insured patients &lt;65 years old with laryngeal cancer, chemoradiation was associated with increased costs, an increased likelihood of treatment\u2010related medical complications, and a reduced likelihood of surgical salvage. Higher\u2010volume surgical care was associated with lower initial treatment and 1\u2010year costs of care. These data have implications for discussions of value and quality in an era of healthcare reform.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2c. <jats:italic>Laryngoscope<\/jats:italic>, 128:91\u2013101, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.26717","type":"journal-article","created":{"date-parts":[[2017,7,7]],"date-time":"2017-07-07T12:53:16Z","timestamp":1499431996000},"page":"91-101","source":"Crossref","is-referenced-by-count":5,"title":["Treatment, short\u2010term outcomes, and costs associated with larynx cancer care in commercially insured patients"],"prefix":"10.1002","volume":"128","author":[{"given":"Andrew T.","family":"Day","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsien\u2010Yen","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Quon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyunseok","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Oncology Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana P.","family":"Kiess","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Eisele","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin D.","family":"Frick","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland U.S.A."},{"name":"Johns Hopkins Carey Business School Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5134-9307","authenticated-orcid":false,"given":"Christine G.","family":"Gourin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Medical Institutions Baltimore Maryland U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,7,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199106133242402"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa031317"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.129.1.44"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.19.5875"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.124.9.951"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000236095.97947.26"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.07.012"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.171"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27419"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21022"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1997.01900050021002"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.133.12.1270"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.134.4.370"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24574"},{"key":"e_1_2_6_16_1","unstructured":"Metropolitan and micropolitan.U.S. Census Bureau website. Available at:https:\/\/www.census.gov\/programs\u2010surveys\/metro\u2010micro.html. Accessed November 28 2015."},{"key":"e_1_2_6_17_1","unstructured":"American fact finder.U.S. Census Bureau website. Available at:http:\/\/factfinder.census.gov\/faces\/nav\/jsf\/pages\/index.xhtml. Accessed November 28 2015."},{"key":"e_1_2_6_18_1","unstructured":"Consumer Price Index inflation calculator. U.S. Department of Labor Bureau of Labor Statistics website. Available at:http:\/\/www.bls.gov\/data\/inflation_calculator.htm. Accessed July 7 2016."},{"key":"e_1_2_6_19_1","unstructured":"U.S. Department of Health & Human Services.Medical expenditure panel survey. Agency for Healthcare Research and Quality website. Available at:http:\/\/meps.ahrq.gov\/mepsweb. Accessed November 28 2015."},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21393"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21348"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24343"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.26717","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.26717","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T20:04:39Z","timestamp":1696017879000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.26717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7,7]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1002\/lary.26717"],"URL":"https:\/\/doi.org\/10.1002\/lary.26717","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"type":"print","value":"0023-852X"},{"type":"electronic","value":"1531-4995"}],"subject":[],"published":{"date-parts":[[2017,7,7]]}}}