Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B149
Session Name: Poster Session
High-cost users among patients with head and neck cancers: a population-based study
Noémie Villemure-Poliquin, MD, MSc1; Rui Fu, PhD2; Qing Li, MSc3; Kelvin K.W. Chan, MD, MSc, PhD2; Irene Karam, MD2; Frances Wright, MD, MEd2; Nathalie G. Coburn, MD, MPH2; Rinku Sutradhar, PhD3; Julie Hallet, MD, MSc2; Antoine Eskander, MD, ScM2; 1University of Toronto; 2Sunnybrook Research Institute (SRI); 3Institute for Clinical and Evaluative SciencesImportance: High-cost users (HCUs) are a small subset of patients responsible for a disproportionately large share of healthcare expenditures. Head and neck cancers (HNC) are associated with significant healthcare costs due to complex treatment regimens and long-term sequelae, making them one of the most resource-intensive cancer types to manage. Given this high baseline cost, identifying HCUs within this patient population is essential for developing targeted interventions that can optimize resource allocation.
Objective: This study aims to identify predictors of being a HCU of publicly funded health care during the first year after the diagnosis among patients with HNC.
Design: A population-based retrospective cross-sectional study was conducted using deterministically linked administrative data from Ontario, Canada. All patients diagnosed with HNC between January 2007 and October 2020 with a full 1.5-year follow-up interval after the diagnosis were included. Total 1-year post-diagnosis healthcare costs were estimated using a patient-level case-costing algorithm from the perspective of the Ontario Ministry of Health and reported in 2020 Canadian Dollar (CAD). Predictors of being a HCU were identified using a multivariable logistic regression model.
Setting: Ontario, Canada (population of 14.7 million people as of October 2020), a province with a universal healthcare insurance system.
Participants: Adult patients diagnosed with HNC between Jan2020-Oct2020 were identified from the provincial cancer registry and followed from the date of diagnosis to the date of death or Oct 31, 2021. Only those with a full 1.5-year follow-up were included (n=13,795) to ensure no overlap with the end-of-life period.
Main Outcomes: A binary variable indicating the status of being a HCU of publicly funded health care over the first post-diagnosis year. HCU was defined as being in the top 25% percentile of the current cohort.
Results: Of our cohort, the overall mean one-year costs after diagnosis were $47,753 CAD (SD: $41,549), with HCUs (n= 3,448 [25%] of the cohort). Cancer stage and treatment modality were the strongest predictors of HCU status: advanced stages III and IV had 5- to 8-fold higher odds of being HCUs, while combined treatment modalities such as surgery + chemoradiotherapy (OR 5.86, 95% CI 4.74-7.24) and surgery + radiotherapy (OR 6.94, 95% CI 5.71-8.43) were associated with the highest odds. Furthermore, patients diagnosed during the pandemic had 73% (OR 1.73, 95% CI 1.05-2.85) higher odds of being HCUs than those diagnosed before the pandemic.
Conclusions and Relevance: This study is the first to provide a detailed assessment of intensive use of health care resources among HNC patients within a universal healthcare setting. Advanced stage, multimodal treatments, and diagnosis during the COVID-19 pandemic significantly increased the likelihood of being a HCU. Targeted interventions for HCUs, including early identification of high-risk patients, and consideration of socioeconomic factors are crucial for healthcare planning and sustainable resource allocation in high-cost cancer care.
Figure 1. Total healthcare costs incurred during the first year after a head and neck cancer diagnosis in the study cohort (n=13,795). The vertical line in the histogram indicates the threshold for the top 25% of healthcare cost users.
