First Analysis of Medicare Costs Associated with Head and Neck Cancers

October 2012, Vol 3, No 7 - Economics of Cancer Care

Toronto, Canada—The first-ever analysis of Medicare payments for head and neck tumors shows that comorbidities and treatment choices are the primary drivers of the costs of each type of cancer; the study results were presented at the 2012 International Conference on Head and Neck Cancer. Consequently, the total 5-year cumulative costs per oral-cavity cancer case are approximately $72,000 and approximately $91,000 for oropharyngeal cancer.

In addition, there was no difference between the costs associated with distant metastases and with localized cancer was not significant for oral-cavity cancer, as well as in the cost for distant (or regional) and localized oro­pharyngeal tumors.

“We observed that mortality does increase significantly for regional and distant metastases—this is part of another analysis of ours that is currently under review,” said coprincipal investigator Christopher Hollenbeak, PhD, Chief, Division of Outcomes, Research and Quality, Pennsylvania State University College of Medicine, Hershey. “We feel that the best explanation for this is patients with regional and distant disease die sooner than patients with local disease. Cum­ulative costs stop upon death, but patients who survive continue to accumulate costs,” Dr Hollenbeak added.

This analysis was based on data from Surveillance Epidemiology and End Results (SEER)-Medicare database for patients aged ≥66 years who had a diagnosis of a first primary tumor of the head or neck between 1995 and 2005. The costs were defined as payments made by Medicare for all-cause medical treatments ranging from emergency department visits to durable medical equipment.

The costs of chemotherapy and most other drugs were not included in the analysis, because this information is not available from the SEER-Medicare database. The results were inflated to 2010 dollars using the Consumer Price Index.

Patients with oral-cavity cancer tended to be older and were more likely to be female and white than those with oropharyngeal cancer. The researchers also analyzed a control group without cancer; this group was age-, sex-, and race-matched in a 2:1 ratio to the cancer cases. The 2 groups had similar demographic characte­ristics.

The 5-year cumulative costs were $71,953 for each case of oral-cavity cancer and $91,393 for each case of pharyngeal cancer. When the patients with cancer were compared with the controls, the 5-year incremental costs were $26,850 higher for oral-cavity cancer and $47,467 higher for oropharyngeal cancer than for the controls.

Patients with oral-cavity cancer and 1 or 2 comorbidities had $13,342 higher cumulative costs than patients with no comorbidities; the cumulative costs for 3 comorbidities totaled $22,196. The increased cumulative costs for oropharyngeal cancer were $14,139 for 1 or 2 comorbidities and $27,799 for 3.

For both types of cancer, significantly higher cumulative costs were seen for surgery, radiation, a combination of surgery and radiation, and chemotherapy compared with no treatment.

Dr Hollenbeak said he and his team will now study cost increases of patients with these 2 types of cancers at the end of life.