Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B321
Session Name: Poster Session
Financial Impact of Treatment for Head and Neck Cutaneous Melanoma and Non-Melanoma Skin Cancers: An Insurance Claims-Based Study
Sachin Narayan1; Sabrina Qi1; Shannon Wu, MD2; Vasu Divi, MD2; 1Stanford University School of Medicine; 2Stanford University School of Medicine, Department of Otolaryngology-Head and Neck SurgeryBackground: Skin cancers, predominantly cutaneous melanomas, squamous cell carcinomas, and basal cell carcinomas, comprise a significant proportion of the caseload for physicians treating head and neck (H&N) cancers. While lower-grade skin cancers are often treated with local excisions, recent advances in immunotherapies and small-molecule inhibitors for melanoma have transformed systemic therapy for more aggressive cancer subtypes. These emerging therapies are diverse and expensive, warranting quantification and comparison of the costs of treatment pathways between cutaneous melanomas and non-melanoma skin cancers.
Methods: We analyzed the MarketScan Commercial Database, which contains patient claims data from 2007-2022. Patients with a diagnosis of cutaneous melanomas or non-melanoma skin cancers were included. Based on prior studies, physician recommendations, the MicroMedex RedBook, and NCCN guidelines, we aggregated Current Procedural Terminology (CPT) codes and generic formulation codes covering six treatment pathways: diagnosis (biopsies, imaging, and cytology), chemotherapy, immunotherapy, radiation therapy (RT), surgery, and clinical trials. Chemotherapy and immunotherapy costs included prescription and infusion costs. This list was used to gather out-of-pocket costs (OOP), defined as the sum of copay, coinsurance, deductible, pharmacy dispensation costs, and total payments to the provider. Comparison between melanoma and non-melanoma skin cancer treatment costs were calculated by Mann-Whitney U-tests or Student t-tests to address outliers and unequal variances.
Results: We identified 70,057 patients with H&N cutaneous melanomas and 1,289,905 patients with H&N non-melanoma skin cancers, with almost all patients seen in outpatient settings (99.6% of melanoma, 96.3% of non-melanoma) (Table 1). OOP and total payment costs (Table 2) were highly significantly different across all treatment buckets except for clinical trials, with melanoma having greater cost for chemotherapy (OOP: $476>$275, p<.0001; Total Pay: $32401>$14297, p<.0001), immunotherapy (OOP: $548>$63, p<.0001; Total Pay: $48209>$4603, p<.0001), diagnostic workup (OOP: $113>$64, p<.0001; Total Pay: $996>$236, p<.0001) and across all treatments (OOP: $512>$399, p<.0001; Total Pay: $8720>$2162, p<.0001). Non-melanoma has a greater OOP cost for RT ($612>$255, p<.0001) and surgery ($240>$188, p<.0001), though melanoma incurs a greater total payment cost in these two categories (RT: $15590>$11294, p<.0001; Surgery: $1481>$1211, p<.0001) (Table 3).
Conclusion: Treatment for cutaneous melanoma was found to cost patients significantly more than non-melanoma skin cancers, likely attributed to the cancer’s aggressiveness and widespread utilization of immunotherapies. Notably, the widespread proliferation of immunotherapies for melanomas was reflected by the higher OOP and total payment costs relative to immunotherapies for non-melanoma. As new therapeutics emerge, care teams should aim to understand the financial implications of particular treatment pathways for H&N skin cancers, allowing informed shared-decision making between patient, family, and provider.
