Potential treatment-cost savings from stage-shift in head and neck cancer in England

Head and neck cancer (HNC) poses a significant and growing economic burden on the NHS. Treatment costs are higher for late-stage disease, yet most patients in England present at advanced stages. Population-level screening may shift stage distribution at diagnosis, but its economic rationale has not previously been quantified using contemporary patient-level cost data.

We undertook a cost analysis using patient-level secondary care treatment data from a tertiary NHS centre, supplemented by a large national population-based NHS cost dataset, epidemiological data, and published health-related quality-of-life estimates. Stage-stratified treatment costs were applied to the reported national stage distributions to model the potential cost impact of a stage shift attributable to screening. Scenario analysis estimated annual NHS-wide treatment cost savings.

Using patient-level costing from a tertiary NHS centre, stage-stratified median treatment costs ranged from £37,201 (stage I) to £60,376 (stage III). A complementary national dataset of 31,184 HNC patients reported mean costs of £32,095 (stage I) versus £43,981 (stage IV) across up to six years of NHS hospital care. Applying these differentials to the approximately 5,720 annual late-stage diagnoses in England, scenario analysis suggests potential treatment cost savings of £6.8-8.0 million per annum from a 10% stage-shift, rising to £20.4-24.0 million annually from a 30% stage-shift. Post-treatment EQ-5D-5L utility values of 0.78-0.79 (intervention group) and 0.75-0.76 (standard care) confirm a substantial quality-adjusted life-year burden in HNC survivors.

This study quantifies the potential treatment-cost savings associated with a stage-shift in HNC diagnosis in England.