DIRECT COSTS OF HEAD AND NECK CANCER IN THE UNITED STATES: ESTIMATES FROM THE 2005-2009 MEDICAL EXPENDITURE PANEL SURVEY (MEPS)

Purpose: Incidence rates of head and neck cancer attributable to vaccine-preventable human papillomavirus (HPV) have been steeply increasing in the US over the past decade.  The cost to society of head and neck cancers in the US is estimated to be over 2 billion dollars.  In addition, the disease has serious effect on a survivor’s quality of life.  We sought to estimate the direct annual healthcare utilization and costs of patients with head and neck cancer from an all-payor perspective.

Method: We conducted a retrospective cross-sectional analysis of the 2005-2009 Medical Expenditure Panel Survey (MEPS) databases.  Patients with clinically diagnosed head and neck cancer were selected and their records were linked to healthcare utilization and expenditure related to their condition.  Statistical analysis accounted for MEPS’ complex survey design, clustering, and weighting.  Costs were converted into 2008 US dollars using the medical consumer price index (CPI).  We assessed patient demographics, insurance type and annual healthcare utilization.  We estimated healthcare expenditures including office visit costs by visit category and procedure, inpatient hospitalization cost by length of stay and procedure, and outpatient visit costs.

Result: We identified 82 patients with head and neck cancer in the MEPS databases (weighted N=166,714). Similar to estimates in the general US population, the majority (72%) of patients were male, with a mean age of 59.8.  Less than 36% of patients were in their first year of illness.  The majority of healthcare utilization consisted of outpatient hospital visits (mean annual number=3.1) and office visits (mean annual number=8.77).  Over 54% of office visits were for diagnosis or treatment of illness, followed by post-operative visits (31%). The average cost of an office visit was $288 with visits containing chemotherapy sessions costing $286 and those with radiotherapy sessions costing $110.  Inpatient hospitalizations averaged 10.7 nights in the hospital with the majority (over 50%) involving a surgical procedure.  The average cost of an inpatient hospitalization was $19,114.

Conclusion: Head and neck cancer represents a significant clinical and economic burden in the United States.  Estimating aggregate and patient-level healthcare costs and utilization associated with head and neck cancer is essential for identifying cost-effective prevention strategies and policies.