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Program Number: B097
Session Name: Poster Session

Medical costs in a universal health system: a population-based case-control study of head and neck cancers

Noémie Villemure-Poliquin, MD, MSc¹; Rui Fu, PhD¹; Qing Li, MSc²; Kelvin K.W. Chan, MD, MSc, PhD³; Irene Karam, MD³; Frances Wright, MD, MEd³; Nathalie G. Coburn, MD, MPH³; Rinku Sutradhar, PhD²; Julie Hallet, MD, MSc³; Antoine Eskander, MD, ScM³; ¹University of Toronto; ²Institute for Clinical and Evaluative Sciences; ³Sunnybrook Health Sciences Centre

Importance: Head and neck cancers (HNC) are the seventh most common malignancy worldwide, with increasing incidence due to HPV-related cancers. In light of advancements in treatment, HNC management involves complex, multimodal therapies that drive substantial healthcare costs. Understanding the direct medical costs by cancer subsite, stage, and treatment modality is critical for optimizing resource allocation, planning healthcare budgets, and evaluating the cost-effectiveness of treatments.

Objective: 1) To quantify total and monthly phase-specific per-person costs attributable to HNC from a public payer perspective (the Ontario Ministry of Health). 2) To compare monthly direct healthcare costs of HNC by cancer-specific characteristics such as subsite and treatment modality.

Design: We conducted a retrospective population-based case-control study using linked Ontario health administrative data. Direct medical costs were estimated using an established patient-level case-costing algorithm and compared between HNC cases and matched non-HNC controls.

Setting: Ontario, Canada (population of 14.7 million people as of October 2020), a province with a universal healthcare insurance system.

Participants: 19,832 adults newly diagnosed with HNC between January 2007 and October 2020 in Ontario were identified from the provincial cancer registry and followed from the date of diagnosis for 5 years or to the date of receiving a new cancer diagnosis, or October 31, 2021, or date of death, whichever occurred first. Each case patient was matched with five controls from the general population who had no HNC diagnosis up to October 31, 2021, and no cancer diagnosis in previous 10 years based on age, sex, and comorbidity.

Exposure: HNC cancer subsite (oral cavity, larynx/hypopharynx, oropharynx), stage (I-IV), and cancer-directed treatment modality (surgery alone, radiotherapy, chemoradiotherapy, surgery with adjuvant radiotherapy, surgery with adjuvant chemoradiotherapy or no treatment/palliative care).

Main Outcome(s) and Measure(s): The primary outcome was the mean per-person monthly costs attributable to HNC, both overall and by phase of care (pre-diagnosis, treatment, and survivorship) reported in 2020 Canadian dollars (CAD). Secondary outcomes included the variation in monthly costs by cancer subsite, stage, and treatment modality.

Results: Mean per-person direct costs attributable to HNC over 63 months were CAD53,812.9 (SD: 63,911.9). Monthly costs peaked in the initial 3 months following diagnosis (CAD 9,709.7). Larynx/hypopharynx cancers and advanced-stage cancers incurred the highest mean costs across most phases of care. Patients receiving multimodal treatment, particularly surgery combined with chemoradiation, had significantly elevated costs in both the initial treatment and survivorship phases compared to single-modality treatment.

Conclusions and Relevance: This study provides a comprehensive understanding of the direct medical costs of HNC, highlighting its overall heavy cost-of-illness burden to the healthcare system and substantial cost variations by cancer subsite, stage, and treatment modality. The findings emphasize the need for optimal resource allocation and tailored care management for high-cost patient groups.

Figure 1.  Monthly (upper) and cumulative (lower) mean costs of the case and the control.

 

 

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