Economic impact of human papillomavirus-associated head and neck cancers in the United States

Lifetime health care costs of oropharyngeal cancer for commercially insured patients in the United States

BACKGROUND

Incidence of oropharyngeal cancer (OPC) is expected to increase but its health care cost is unknown. The purpose for this study was to estimate the phase-specific lifetime health care costs of OPC for commercially insured individuals in the United States.

METHODS

We used the Truven MarketScan Commercial Claims and Encounter Database to identify our patient population. Cox survival analysis was used to estimate patients' monthly survival probabilities. We determined the ratios of the cumulative costs up to a particular survival probability and the costs from that time point to death for all subjects who died before end of the 5-year follow-up period. This relationship was then used to predict phase-specific lifetime health care costs.

RESULTS

Our study included 2445 patients with OPC. The predicted phase-specific lifetime health care costs attributable to OPC were $88 872, $24 038, and $1537 in the initial, continuous, and terminal phases, respectively, among commercially insured patients.

Medical Care Cost of Oropharyngeal Cancer among Texas Patients

Background: The incidence of oropharyngeal cancer is rising rapidly, with the majority of cases being attributable to human papillomavirus (HPV). Despite the availability of a vaccine, rates of HPV vaccination among Texas youth are low. The healthcare cost of oropharyngeal cancer in Texas is unknown. The aims of this study were to estimate the first 2-year cost of treating new cases of oropharyngeal cancer and determine the predictors of oropharyngeal cancer treatment cost in Texas.Methods: This study included a retrospective cohort of 467 Texas patients with commercial insurance claims data with oropharyngeal cancer diagnosed from 2011 to 2014 and a control group of 467 noncancer patients obtained with propensity score matching. Total healthcare cost during the first 2 years after the index date was measured. A generalized linear model was used to identify predictors of monthly cost during the 2 years after the index date.Results: The mean differential adjusted healthcare cost for oropharyngeal cancer cases was $139,749 in the first 2 years. The mean adjusted monthly cost in the first 2 years was $6,693 for cases and $870 for controls. Age, comorbidity, mental health, prediagnostic healthcare cost, and time index were significant predictors of monthly cost.Conclusions: Medical care cost was about $140,000 in the first 2 years after diagnosis of oropharyngeal cancer among commercially insured patients in Texas.Impact: The cost estimates provide important parameters for development of decision-analytic models to inform decision makers about the potential value of initiatives for increasing the HPV immunization rate in the state. Cancer Epidemiol Biomarkers Prev; 26(9); 1443-9. ©2017 AACR.

Secondary Primary Malignancy Risk in Patients With Cervical Cancer in Taiwan: A Nationwide Population-Based Study

To evaluate the risk of secondary primary malignancy (SPM) in patients with cervical cancer using a nationwide population-based dataset.Patients newly diagnosed with cervical cancer between 1997 and 2011 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated by comparing with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models.During the 14-year study period (follow-up of 223,062 person-years), 2004 cancers developed in 35,175 patients with cervical cancer. The SIR for all cancers was 1.56 (95% confidence interval, 1.50-1.63, P < 0.001). SIRs for follow-up periods of >10, 5 to 10, 1 to 5, and <1 year were 1.37, 1.51, 1.34, and 2.59, respectively. After the exclusion of SPM occurring within 1 year of cervical cancer diagnosis, SIRs were significantly higher for cancers of the esophagus (2.05), stomach (1.38), colon, rectum, and anus (1.36); lung and mediastinum (2.28), bone and soft tissue (2.23), uterus (3.76), bladder (2.26), and kidneys (1.41). Multivariate analysis showed that age ≥60 was a significant SPM risk factor (hazard ratio [HR] 1.59). Different treatments for cervical cancer, including radiotherapy (HR 1.41) and chemotherapy (HR 1.27), had different impacts on SPM risk. Carboplatin and fluorouracil independently increased SPM risk in cervical cancer patients.Patients with cervical cancer are at increased risk of SPM development. Age ≥60 years, chemotherapy, and radiotherapy are independent risk factors. Carboplatin and fluorouracil also increased SPM risk independently. Close surveillance of patients at high risk should be considered for the early detection of SPMs.

Productivity Losses Associated with Head and Neck Cancer Using the Human Capital and Friction Cost Approaches

OBJECTIVES

Previous studies suggest that productivity losses associated with head and neck cancer (HNC) are higher than in other cancers. These studies have only assessed a single aspect of productivity loss, such as temporary absenteeism or premature mortality, and have only used the Human Capital Approach (HCA). The Friction Cost Approach (FCA) is increasingly recommended, although has not previously been used to assess lost production from HNC. The aim of this study was to estimate the lost productivity associated with HNC due to different types of absenteeism and premature mortality, using both the HCA and FCA.

METHODS

Survey data on employment status were collected from 251 HNC survivors in Ireland and combined with population-level survival estimates and national wage data. The cost of temporary and permanent time off work, reduced working hours and premature mortality using both the HCA and FCA were calculated.

RESULTS

Estimated total productivity losses per employed person of working age were EUR253,800 using HCA and EUR6800 using FCA. The main driver of HCA costs was premature mortality (38% of total) while for FCA it was temporary time off (73% of total).

CONCLUSIONS

The productivity losses associated with head and neck cancer are substantial, and return to work assistance could form an important part of rehabilitation. Use of both the HCA and FCA approaches allowed different drivers of productivity losses to be identified, due to the different assumptions of the two methods. For future estimates of productivity losses, the use of both approaches may be pragmatic.

Long-term workforce participation patterns following head and neck cancer

PURPOSE

This analysis describes the long-term workforce participation patterns of individuals diagnosed with head and neck cancer (HNC).

METHODS

Survivors of HNC (ICD10 C00-C14, C32) diagnosed at least 8 months previously were identified from the National Cancer Registry Ireland and sent a survey including questions about working arrangements before and since diagnosis. Descriptive statistics and multivariate logistic regression were used to examine the factors that influence workforce participation at 0, 1 and 5 years after diagnosis.

RESULTS

Two hundred sixty-four individuals employed at the time of diagnosis responded to the survey, an average 6 years post-diagnosis. Seventy-seven percent took time off work after diagnosis, with a mean work absence of 9 months (range 0-65 months). Fifty-two percent of participants reduced their working hours (mean reduction 15 h/week). The odds of workforce participation following HNC were increased by not being eligible for free medical care (OR 2.61, 95% CI 1.15-5.94), having lip, mouth or salivary gland cancer (compared to cancer of the pharynx or cancer of the larynx, OR 2.79, 1.20-6.46), being self-employed (OR 2.01, 1.07-3.80), having private health insurance (OR 2.06, 1.11-3.85) and not receiving chemotherapy (OR 2.82, 1.31-6.06). After 5 years, only the effect of medical card remained (i.e., medical insurance) (OR 4.03, 1.69-9.62).

CONCLUSIONS

Workforce participation patterns after HNC are complex and are influenced by cancer, treatment and employment factors.

IMPLICATIONS FOR CANCER SURVIVORS

Patients should be informed of the potential impacts of HNC on workforce participation, and clinicians, policy makers and employers should be aware of these potential longer-term effects and related variables.