title: Laryngeal cancer cost analysis: association of case-mix and treatment characteristics with medical charges.
abstract: OBJECTIVE
  To examine the relationship of various pretreatment case-mix characteristics and treatment modalities with medical charges incurred during diagnosis, treatment, and 2-year follow-up for patients with laryngeal cancer.
  
  
  METHODS
  Retrospective chart review and billing record analysis.
  
  
  METHODS
  The charts and billing records of patients diagnosed with laryngeal cancer at the University of Iowa Hospitals and Clinics (UIHC) between January 1, 1991 and December 31, 1994 were reviewed. The independent variables included various pretreatment patient-mix and tumor characteristics (age, AJCC TNM clinical stage, smoking history, ASA class, and comorbidity as defined by Kaplan-Feinstein grade) as well as type of treatment. The dependent variables included total physician, office, and university hospital-based charges incurred during the pretreatment evaluation and 0- to 3-, 3- to 12, and 12- to 24-month billing periods after the initiation of cancer-directed therapy. Total 1-year and 2-year charges were also evaluated. Univariate and multivariate analyses were used to investigate the relationships between dependent and independent variables and to develop models predictive of management charges during the individual and total billing periods.
  
  
  RESULTS
  Pretreatment charges showed no significant associations (P < .05) with any of the independent variables. Multiple regression analyses indicated that comorbidity, stage, and initial treatment modality were significant variables in one or more of the models predicting charges incurred during the 0- to 3-month, 3- to 12-month, total 1-year, and total 2-year billing periods. The models yielded R2 values for the total 1- and 2-year billing periods of 0.5246 and 0.5055, respectively.
  
  
  CONCLUSIONS
  This work supports continued study of measures that may result in earlier detection of laryngeal cancer as a potential means of reducing management charges. These results also indicate that a more accurate method of stratifying the disease severity of laryngeal cancer patients for reimbursement purposes would include measurements of the severity of the index disease as well as comorbid diseases.
authors.affiliation: Department of Otolaryngology--Head and Neck Surgery, University of Miami, Florida, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Arnold
authors.forename: G F
authors.initials: GF
authors.lastname: Funk
authors.forename: L H
authors.initials: LH
authors.lastname: Karnell
authors.forename: A H
authors.initials: AH
authors.lastname: Chen
authors.forename: H T
authors.initials: HT
authors.lastname: Hoffman
authors.forename: J M
authors.initials: JM
authors.lastname: Ricks
authors.forename: M B
authors.initials: MB
authors.lastname: Zimmerman
authors.forename: D P
authors.initials: DP
authors.lastname: Corbae
authors.forename: W
authors.initials: W
authors.lastname: Zhen
authors.forename: T M
authors.initials: TM
authors.lastname: McCulloch
authors.forename: S M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002277:Carcinoma / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D003365:Costs and Cost Analysis / Q000191:economics / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups / Q000191:economics* / Q000706:statistics & numerical data; D004180:Direct Service Costs / Q000706:statistics & numerical data; D005251:Fees, Medical / Q000706:statistics & numerical data; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007484:Iowa; D007822:Laryngeal Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013997:Time Factors