title: The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, Medicare, and Medicaid.
abstract: BACKGROUND
  Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated.
  
  
  METHODS
  A retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients.
  
  
  RESULTS
  Total annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population.
  
  
  CONCLUSIONS
  In the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.
authors.affiliation: Delta Dental of Michigan, University of Michigan, 4100 Okemos Road, Okemos, MI 48864, USA. jjacobson@deltadentalmi.com
authors.forename: Jed J
authors.initials: JJ
authors.lastname: Jacobson
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Eichmiller
authors.forename: Teresa B
authors.initials: TB
authors.lastname: Gibson
authors.forename: Ginger S
authors.initials: GS
authors.lastname: Carls
authors.forename: Emily
authors.initials: E
authors.lastname: Vogtmann
authors.forename: Shaohung
authors.initials: S
authors.lastname: Wang
authors.forename: Barbara
authors.initials: B
authors.lastname: Murphy
mesh_terms: D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000191:economics*; D010610:Pharyngeal Neoplasms / Q000191:economics*; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000191:economics*; D014481:United States