Study: Oral cancers take financial toll

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The cost of treating individuals with oral, oropharyngeal, and salivary gland cancers is significant, particularly for patients who undergo all three forms of treatment, according to a new study by Delta Dental of Michigan's Research and Data Institute. And for many that is only the beginning of the financial impact of the disease.

The project, which involved Thomson Reuters, Delta Dental of Wisconsin, Vanderbilt University, and the University of Illinois at Chicago College of Dentistry, began in March 2010. It is the first retrospective data analysis of a large number of head and neck cancer patients in the U.S. analyzing direct and indirect costs and comparing those costs to a matched comparison group, according to the authors (Head Neck Onc, April 26, 2012).

Using data from the 2004-2008 Thomson Reuters MarketScan Databases: Commercial Claims and Encounters Database, Medicare Supplemental and Coordination of Benefits Database, Medicaid Multi-State Database, and the Health Productivity and Management Database, the researchers retrospectively analyzed claims data of 6,812 OC/OP/SG patients with employer-sponsored health insurance, Medicare, or Medicaid benefits.

“To our knowledge, this is the first study of its kind.”
— Jed Jacobson, Chief Science Officer, Delta Dental

They found that, on average, total annual healthcare spending during the year following diagnosis was $79,151, compared with $7,419 in a group comprising similar patients without these cancers. They also found that the average cost of care almost doubled when patients received all three types of treatment: surgery, radiation, and chemotherapy.

Healthcare costs were higher for oral 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), the study found. 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 care, from $96,520 in the Medicare population to $153,892 in the commercial population.

"The results of this research are significant in helping us to fully understand the cost burden of these three particular head and neck cancers on patients and health care providers," stated Jed Jacobson, DDS, MS, MPH, chief science officer at Delta Dental and a lead contributor to the study, in a press release. "To our knowledge, this is the first study of its kind."

One of the big problems with oral cancer is that it is uncovered so late in the disease that the chances of survival are terrible, he added.

"So the key is early detection and diagnosis," Dr. Jacobson said. "In the last decade, we have seen a flurry of activity in new science and technology with the promise of being able to find it earlier. The problem is, should I as a purchaser of healthcare buy this benefit? The answer is often return on investment: if I spend a dollar on this new technology, do I save anything relative to finding the cancer earlier? So we need to know what oral cancer costs."

Social, psychological, economic impact

The project examined other factors also, including:

  • Indirect costs associated with these cancers from diagnosis, treatment, and recovery, such as absenteeism, worker productivity, and the disabling and disfiguring side effects of treatment
  • The cost burden of oral cancer on taxpayers who fund Medicaid and Medicare
  • The comparative value of preventive care for these oral cancers versus treatment

"Most oral cancers require costly and disfiguring medical intervention, and even then the five-year survival rate is approximately just 60%," Dr. Jacobson said. "Yet when the cancer is detected early, the survival rate increases to 83%. This study allows us to get a better handle on the cost impact these diseases have and how we can combat them better."

Head and neck cancers have always piqued the interest of health care providers, patients, and insurers because of the high-morbidity, high cost of care, and high-mortality rates associated with them. Yet, it has largely remained an unexplored area when it comes to research and backing up these conclusions.

"The actual study of the social, psychological, and economic impacts of these cancers has been understudied," states Dr. Joel Epstein, former professor of oral medicine and diagnostic sciences at the University of Illinois in Chicago, now adjunct professor, director of oral medicine at City of Hope in Duarte, CA. "These are the reasons we decided to conduct this important research and be able to shed more light on the cost burden of treating head and neck cancer."

By including screening as part of regular dental exams, dentists and hygienists have the opportunity to detect these cancers early, decreasing morbidity and mortality, the study authors noted. In addition, educational programs to raise awareness among health care providers and programs instructing individuals on self-examination may result in earlier detection and greatly reduce the high cost and mortality of oral and head and neck cancers.

"The information [in this study] will be a great asset in determining the cost-effectiveness of any new technologies and early detection systems that could potentially help decrease costs, and more importantly, lower the mortality rate of these cancers down the road," Dr. Jacobson concluded.

However, while the findings of this study are important, it does not address the additional financial burden many oral cancer survivors face after treatment, noted Brian Hill, executive director of the Oral Cancer Foundation.

"If you look at the financial consequences in this economy, by not finding this disease early, the morbidity associated with treatments is significant," he told "But also, treatment is just the beginning of the financial cascade of events. There are larger consequences to the economy. It isn’t just about survival, but other long-term consequences insurance wise, personally, and at the government level also due to long-term disability."

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