The economic burden of oral squamous cell carcinoma in Australia

Abstract

Objectives The financial burden of treatment for oral squamous cell carcinoma in Australia has never been reported, and there is a paucity of international data. Here, we report the direct costs of treatment of surgically resectable oral cancer in a tertiary public hospital in Australia over a 15‐year period. Materials and Methods Pathology department records, records of hospital attendance and hospital finance department records were interrogated to determine the direct costs of inpatient and outpatient treatment. Costs were adjusted using the total health price index so that all costs were equivalent to costings for the 2016/2017 financial year. Results A total of 113 cases were identified as suitable for inclusion. Complete inpatient and outpatient hospital attendance and costing data for treatment and subsequent 2‐year follow‐up was available for 29 cases. The average total cost over the 2‐year period was $92 958AUD (median $102 722, range $11 662‐$181 512). On average, 92.8% of costs were incurred in the first year post‐diagnosis. Inpatient costs, outpatient costs and total costs increased with increasing pathological cancer stage. Both 1‐ and 2‐year post‐diagnosis overall cost for patients with Stage 4 oral cavity cancer were more than two times greater than for patients with Stage 1 oral cancer. Conclusion It is well documented that patients diagnosed at an earlier stage will have better survival outcomes, and it is assumed that the economic burden of their treatment will be less. We have shown that there is a direct correlation between cancer stage and cancer treatment cost. The findings provide clear economic support for oral cancer screening initiatives to detect earlier stage cancers, and the need to investigate novel techniques and technologies to detect oral squamous cell carcinoma early and reduce recurrence and mortality rates.

Provider cost of treating oral potentially malignant disorders and oral cancer in Malaysian public hospitals

“…Treating Stage III and IV cancers were more expensive in the initial phase and gave rise to higher expenditure over the total management period relative to early-stage cancer and OPMD. Our results notably echoed the findings from numerous studies worldwide illustrating the higher economic burden of treating late-stage oral cancer [ 28 , 33 , 35 , 37 ]. The global trend was generally due to a higher percentage of multimodal cancer treatment and extended hospitalization in later stages.…”

“…Our average cost of treatment of MYR 52,113 (USD 32,530) in early-stage and MYR 70,975 (USD 44,304) in late-stage cancer was shown to be comparable to the findings by Epstein et al in California, based on Medicaid reimbursement data inflated to the year 2019 [ 27 ]. However, it was predominantly lower than the rest of the studies conducted in developed nations but higher than those in developing countries such as India, Sri Lanka, and Iran ( S4 Table ) [ 28 – 36 ]. The comparison showed a clear distinction in healthcare tariffs between countries.…”

“…The selection of analytical methods to generate mean healthcare cost is critical, especially to project exact and precise values. The standard in cost analysis will be the enumeration of a sufficiently powered sample size over one year [ 23 , 28 , 35 ]. Such practice provides an accurate annual cost and distribution while avoiding the difficulty of censored cases.…”

“…[27]. However, it was predominantly lower than the rest of the studies conducted in developed nations but higher than those in developing countries such as India, Sri Lanka, and Iran (S4 Table) [28][29][30][31][32][33][34][35][36]. The comparison showed a clear distinction in healthcare tariffs between countries.…”

A keratinised lump on the lateral surface of the tongue

“…OSCCs double in size every three months, 9 so it is imperative that general practitioners initiate appropriate referral pathways for suspected OSCC. The use of new optical and surgical approaches can improve disease-free survival 10 and reduce the economic burden of OSCC, 11 but early diagnosis remains the primary prognostic factor.…”