Determinants of medicare costs for elderly patients with oral cavity and pharyngeal cancers

IMPORTANCE In the United States, nearly 8400 patients die each year from oral cavity and pharynx cancers, most of whom are 65 years and older; however, the costs attributable to these cancers are not well described. OBJECTIVE To identify the primary determinants of cost in patients with oral and pharyngeal cancer. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort analysis of data from Medicare and Surveillance, Epidemiology, and End Results hospitals (January 1, 1995, through December 31, 2005), we studied patients 66 years and older with newly diagnosed oral cavity (n = 6724) and pharyngeal (n = 3987) cancers. MAIN OUTCOMES AND MEASURES Five-year cumulative costs, defined as Medicare Parts A and B payments, were estimated using inverse probability weighting. Linear regression analysis with inverse probability weighting was used in multivariate analyses of costs to estimate the effects of covariates on cumulative costs. RESULTS In multivariate analyses, costs were significantly increased by demographics, comorbidities, and treatment selection. Compared with white patients, African Americans accumulated $11 450 (95%CI, $1320-$22 299) and $25 093 (95%CI, $14 917-$34 985) more in costs for oral cavity and pharyngeal cancers, respectively. The presence of 1 or 2 comorbidities increased the mean 5-year cumulative costs by $13 342 (95%CI, $6248-$19 186) and $14 139 (95%CI, $6009-$22 217) for patients with oral cavity and pharyngeal cancers, respectively. For 3 or more comorbidities, the mean 5-year cumulative costs increased by $22 196 (95%CI, $15 319-$28 614) and $27 799 (95%CI, $19 139-$36 702) for patients with oral cavity and pharyngeal cancers, respectively. Patients who received chemotherapy accumulated a mean of $26 919 (95%CI, $18 309-$35 056) and $37 407 (95%CI, $29 971-$44 644) more in costs by 5 years for oral cavity and pharyngeal cancers, respectively. CONCLUSIONS AND RELEVANCE Oral and pharyngeal cancer is burdensome to elderly patients from a Medicare cost perspective. Several factors were associated with 5-year costs, including some modifiable factors that may be potential targets for interventions to reduce overall costs.