Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B240
Session Name: Poster Session
Cost Comparison of Treatment Approaches between Patients with Oral Cavity and Oropharyngeal Primary Tumors
Sabrina Qi, BS1; Sachin Narayan, BS1; Shannon Wu, MD2; Vasu Divi, MD2; 1Stanford University School of Medicine; 2Stanford University School of Medicine, Department of Otolaryngology-Head and Neck SurgeryBackground: Cancers of the oral cavity (OC) and oropharynx (OP) are among the costliest cancers to treat, given their requirements for multimodality treatments, ancillary services, and novel therapies. Prior studies have demonstrated that patients undergoing multimodality therapies of chemotherapy, radiotherapy (RT), and surgery had the highest total and out-of-pocket (OOP) costs. Treatments for OC and OP squamous cell carcinoma (SCC) have shifted, with a greater number of OP tumors undergoing definitive chemoradiation, novel immunotherapies and small-molecule inhibitors. The impact of changes in treatment paradigms on patients have not been characterized. To better understand the financial implications to patients, our study aimed to quantify the total and OOP costs compared between OC and OP.
Methods: Patients with a diagnosis of OC or OP SCC were queried in the insurance claims Marketscan database from 2007-2022. Costs of overall care were compared between OC versus OP SCC by treatment type: diagnostic workup, chemotherapy, immunotherapy, RT, surgery, and clinical trials. The database was queried using a comprehensive list of Current Procedural Terminologies (CPT) codes for diagnostic workup (imaging, biopsy, pathology, laboratory tests, and genetic testing), RT, and surgical procedures; generic drug IDs for chemotherapies and immunotherapies; and ICDs were queried for procedure-related clinical encounters for RT, surgery, and clinical trials. Average total OOP costs were calculated as a sum of the average coinsurance, copay, and deductibles from each patient’s treatments. Average total gross payment represents the full amount charged for a healthcare service, including insurance and OOP.
Results: In total, 132,320 patients were evaluated, of which 70,605 (53.4%) had OC tumors and 61,715 (46.6%) had OP tumors. 43,478 (61.68%) OC patients and 46,127 (74.7)% of OP patients were male (Table 1). The total payment for all medical expenditures were significantly higher in OP than OC (14,297 vs 10,195 USD, p<.001). Although the OOP cost for chemotherapy was not significantly different between tumor types (275 vs 238 USD, p=.45). The OOP and total costs for immunotherapy and RT were significantly higher for OP than OC (95.9 vs 72.3 USD, p<.001; Total: 6119 vs 5508 USD, p<.001). The OOP cost for surgery were significantly higher for OC (324 vs 212 USD, p<.001), although the total payment was not significantly different (4894 vs 4495 USD, p=.33). The costs of diagnostic workup were significantly higher for OP (OOP: 193 vs. 162 USD, p<.001; Total: 1876 vs 1403 USD, p<.001). Finally, the costs of treating a patient through a clinical trial is more expensive for OP (OOP: 285 vs 213 USD, p<.001; Total: 15716 vs 9854 USD, p<.001). Comprehensive cost of treatment across categories is significantly higher for OP tumors than OC (OOP: 1308 vs 736 USD, p<.001; Total: 39049 vs 19345 USD, p<.001) (Table 2).
Conclusion: In the era of greater price transparency and with the goal of empowering financial wellbeing, our study quantifies the real-world OOP and total medical expenditures of these cancers. Our findings highlight that diagnostic workup, immunotherapy, and radiation costs are significantly higher among OP cancers, but surgical costs are higher for OC cancers.
