The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, medicare, and medicaid

Abstract

BackgroundHead and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated.MethodsA retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients.ResultsTotal annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population.ConclusionsIn the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.

Analysis of Charges Associated with Definitive Nonsurgical Therapy for Early-Stage Lateralized Tonsil Cancer

“…7 A recent study examining the cost burden of oral, oropharyngeal, and salivary gland cancers found it to be higher for these head and neck cancers than most other types of cancer. 4 The healthcare cost expenditure for post-surgical head and neck cancer patients nearly triples after their index diagnosis. 8 With the care of head and neck cancer patients already being more expensive than the care of most other cancers, 4 consideration of cost should increasingly play a role in deciding among treatments of comparative effectiveness.…”

“…Recent studies have used insurance claims data to identify costs, 4,8,9 focusing either on disease type 4,9 or treatment type. 8 While having the advantage of determining actual cost, relying on claims coding to identify patients and treatments is not without fault; 24.5% to 67.1% of patients identified by a diagnosis of cancer had no consequent identifiable treatment.…”

“…This is especially important since the care of head and neck cancer patients is presently among the most costly types of cancer care. 4 …”

The benefit and risk of screening for oral potentially malignant epithelial lesions and squamous cell carcinoma

“…Most cases of OSCC and OPC continue to be diagnosed at an advanced stage, resulting in the need for more complex and more costly therapy and ultimately compromising favorable outcomes. 7,8 Premalignant, potentially detectable lesions are expected in the majority of OSCC, but it is not known if OPC arises from potentially clinically detectable precursor lesions. It is anticipated that increasing early detection and management of OPMD and early-stage SCC will lead to improved outcomes.…”

Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time

“…Additionally, urgent and emergent dental needs may be managed when the patient is best able to tolerate the treatment, provided at a time of lowest risk to the patient or with appropriate medical support, to facilitate best outcomes which may reduce the need for additional hospitalization and intensive medical care that may impact survival and increase economic burden of treatment [9,18,19,28,60,61]. Therefore, oral and dental care before, during, and following cancer therapy are an important part of cancer treatment [7] and are best provided by educated and experienced dental providers, with good communication with the oncology team [47].…”