The economic cost of squamous cell cancer of the head and neck: findings from linked SEER-Medicare data.
OBJECTIVE
To evaluate the excess mortality, resource use, and costs associated with squamous cell carcinoma of the head and neck (SCCHN) among elderly Medicare beneficiaries.


METHODS
Retrospective cohort analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute and Medicare claims.


METHODS
Study cohorts included patients aged 65 years and older who were newly diagnosed as having SCCHN in a SEER registry between 1991 and 1993 (N = 4536) and controls matched 1:1 by age and sex. Patients were followed up for 5 years or until death, whichever occurred first.


RESULTS
Initial treatment was primarily surgery and/or radiation among patients with early-stage SCCHN, with only modest use of chemotherapy. Patients with SCCHN had significantly (P<.001) higher 5-year mortality (64% vs 25%) and health care costs than controls. Average Medicare payments (1998 US dollars) among patients with SCCHN were $25 542 higher than those of matched comparison patients (P<.001), with monthly payments 3 times as high ($1428 vs $446). Patients diagnosed as having advanced SCCHN had shorter survival times (5-year mortality, 85%, 75%, 47%, and 35% among patients diagnosed as having distant, regional, local, and in situ cancer, respectively) and higher costs (average total Medicare payments, $53 741, $58 387, $42 698, and $37 434, respectively).


CONCLUSIONS
These results suggest that the health economic burden of SCCHN is substantial, with costs that are comparable with or higher than those of other solid tumors.
Lang
Kathleen
K
Boston Health Economics Inc, Waltham, Mass, USA.
Menzin
Joseph
J
Earle
Craig C
CC
Jacobson
Jerilynn
J
Hsu
Ming-Ann
MA
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D006278:Medicare; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology