Key Drivers of High Costs in Head and Neck Cancer Care

TOPLINE:

Advanced disease stage was the strongest predictor of high first-year healthcare costs in Canadian patients with head and neck cancer, a recent analysis found. Patients with stage IV disease had an almost ninefold greater likelihood for high healthcare costs than those with stage I disease. Combination treatments — especially surgery with adjuvant therapy — were also a major driver of high costs.

METHODOLOGY:

• Patients with head and neck cancer experience considerable healthcare burdens due to aggressive and complex multimodal treatments, as well as long-term complications requiring rehabilitation and supportive care. Identifying predictors of high first-year costs can guide strategies to optimize resource use and improve patient outcomes.
• Researchers conducted a population-based retrospective cohort study using data from 13,795 Ontario, Canada, residents (mean age, 63.2 years; 25% women) who were diagnosed with head and neck cancer between January 2007 and October 2020.
• Researchers estimated total 1-year healthcare costs using a patient-level algorithm, with values adjusted to 2020 Canadian dollars (CAD), and identified predictors for high healthcare costs.
• Overall, 25% of patients were classified in the high-cost group (≥ 75th percentile; n = 3448), and 75% were classified in the low- or medium-cost group (< 75th percentile; n = 10,347).
• Patients in the high-cost vs low- or medium-cost groups were more likely to receive chemoradiotherapy (31.5% vs 19.0%), surgery with radiotherapy (20.0% vs 5.7%), or surgery with chemoradiotherapy (14.4% vs 4.1%), and were less likely to receive surgery alone (11.5% vs 27.4%) or radiotherapy alone (16.7% vs 26.1%).

TAKEAWAY:

• Over 1 year, the biggest costs for patients in the high-cost group were inpatient stays (representing 41.0% of costs or CA$40,796 vs CA$5769 in the lower-cost group), outpatient visits (33.5% or $33,321 vs $16,953), physician services (12.5% or $12,436 vs $4959), complex and home care (8.7% or $8677 vs $1272), and drugs, devices, and lab tests (4.2% or $4208 vs $1576).
• Stage II (odds ratio [OR], 3.14), stage III (OR, 6.08), and stage IV (OR, 8.94) were associated with progressively greater odds of high healthcare costs than stage I disease.
• Combination treatment was associated with substantially greater odds of high costs than no treatment or palliative care (OR, 6.94 for surgery and radiotherapy; OR, 5.86 for surgery with chemoradiotherapy).
• Female sex (OR, 1.26) and older age (per each 10-year increase in age at diagnosis; OR, 1.07) were both associated with increased odds of high costs, as were diagnoses during the COVID pandemic (OR, 1.73) compared with prior years.

IN PRACTICE:

“This cohort study found that more advanced disease stage and receiving multiple treatment modalities were the strongest predictors of high-cost care among patients diagnosed with head and neck cancer,” the authors of the study wrote. Potential solutions, they noted, include effective screening programs to promote earlier diagnosis, as well as interventions aimed at treatment de-escalation in appropriately selected patients.

SOURCE:

This study, led by Noémie Villemure-Poliquin, MD, MSc, Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, was published online in JAMA Otolaryngology-Head & Neck Surgery.

LIMITATIONS:

This study included only patients in Ontario, so findings may not be generalizable to other settings. Reliance on administrative data could have led to misclassification of disease severity and treatment types. Additionally, the analysis did not capture direct out-of-pocket costs.

DISCLOSURES:

This study received support through a grant from the Ontario Ministry of Health and the Ontario Ministry of Long-Term Care. One author reported receiving personal fees from EMD Serono and nonfinancial support from Elekta. Another author reported receiving personal fees from Cancer Care Ontario. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.