Geographic variation in Medicare treatment costs and outcomes for advanced head and neck cancer.
Advanced head and neck cancer (HNC) is a complex group of diseases that requires the input and coordination of multiple providers. While there are general guidelines for treatment, there is also considerable variation in how patients are treated, and how long they survive after treatment. It is unclear how the treatment variations relate to treatment costs and survival.



We identified 3678 Medicare patients with advanced HNC treated in 12 US regions between 2004 and 2009 using the linked database containing Medicare and Surveillance Epidemiology and End Results (SEER) data. We calculated average cost per patient during the period three months before to 12months after diagnosis for each region. Costs included inpatient hospital, outpatient, physician, and durable medical equipment charges. We also calculated three-year overall survival for each of the regions.



The mean cost-per-patient varied substantially among the regions, ranging from $51,857 for Utah to $82,181 for Detroit. Utah incurred the lowest total costs within one year of advanced HNC diagnosis ($51,857 per patient, 95% CI $42,285-$61,429), whereas Detroit had the highest costs ($82,181 per patient, 95% CI $74,752-$89,610). Overall survival also varied among the regions, ranging from 45months in Kentucky to 58months in Washington. There was little correlation between expenditures and length of survival, with correlation coefficient of 0.0088.



Despite significant variation in both expenditures and survival among the regions, we found no correlation between costs and mean survival time, suggesting that more costly care did not lead to improved outcomes.
Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, United States. Electronic address: vdivi@stanford.edu.
Vasu
V
Divi
Cancer Prevention Institute of California, Fremont, CA, United States. Electronic address: Li.Tao@cpic.org.
Li
L
Tao
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford, CA, United States. Electronic address: alicesw@stanford.edu.
Alice
A
Whittemore
Cancer Prevention Institute of California, Fremont, CA, United States; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford, CA, United States; Canary Center at Stanford for Cancer Early Detection, Stanford, CA, United States. Electronic address: Ingrid.Oakley-Girvan@cpic.org.
Ingrid
I
Oakley-Girvan
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005843:Geography; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States
Cost effectiveness; Head and neck cancer; Medicare; Oral cancer; Spending; Survival