The cost of major head and neck cancer surgery.

Aim: This study quantified the cost of major head and neck cancer (HNC) surgery.

Methods: Consecutive patients undergoing major HNC surgery between July 2007 and June 2012 were identified from our head and neck database. Patient demographics, tumour type, site, stage and types of resection and reconstruction, length of stay and surgical complications occurring within six months of initial surgery were retrospectively analysed. The actual cost of initial surgical treatment and hospital income were calculated.

Results: Two hundred and forty-five patients underwent major HNC surgery, most commonly for mucosal squamous cell carcinoma (SCC) and metastatic and/or locally advanced cutaneous SCC. Neck dissection and parotidectomy were the commonest resection procedures and free flaps the commonest reconstructive procedures performed. Forty-two patients developed surgical complications within six months of the initial major HNC surgery. Over the five-year period, surgery cost a total of NZ$5,130,639.00, averaging NZ$20,941.38 per patient, not including costs such as incidentals, while the hospital received NZ$4,976,559.61 averaging NZ$20,229.91/patient. On average, oral cavity cancer, metastatic and/or locally advanced skin cancer, and skull base cancer cost NZ$22,694.72/patient, NZ$17,373.64/patient and NZ$47,295.95/patient, respectively.

Conclusion: Calculated hospital income marginally covered the actual cost of major HNC surgery, which places substantial financial burden on the hospital. The anatomic site of the tumour determines the cost of treatment.