Patients With Head and Neck Cancer and High Health Care Costs: A Population-Based Study.

IMPORTANCE

The care for a small subset of patients is responsible for a disproportionately large share of health care expenditures. Head and neck cancer is associated with significant health care costs due to complex treatment regimens and long-term sequelae. Given this high baseline cost, identifying patients with high care costs within a population with cancer might help inform interventions to optimize resource allocation.

OBJECTIVE

To characterize patients with head and neck cancer with the highest health care costs during the first year after diagnosis.

DESIGN, SETTING, AND PARTICIPANTS: A population-based, retrospective cohort study was conducted using administrative data from the Institute for Clinical and Evaluative Sciences in Ontario, Canada, and included adults diagnosed with head and neck cancer between January 2007 and October 2020 (identified from the provincial cancer registry) with a full 1.5-year follow-up from the date of diagnosis to the date of death or October 31, 2021. The total 1-year health care costs were estimated using a patient-level algorithm and were collected in 2020 Canadian dollar values. The main analyses were performed in April 2023 and a sensitivity analysis was performed in April 2025.

MAIN OUTCOMES AND MEASURES

High health care costs (>75th percentile) during the first year after a head and neck cancer diagnosis. Predictors of high health care costs were identified using a multivariable logistic regression model.

RESULTS

The cohort included 13 795 patients (mean age, 63.2 [SD, 11.7] years and 3452 [25.0%] were female), 3448 (25%) of whom had high health care costs. Cancer stage was the strongest predictor of high health care costs. Compared with patients with stage I cancer, those with stage II cancer had 2-fold greater odds for high health care costs (odds ratio [OR], 3.14 [95% CI, 2.56-3.84]), those with stage III cancer had 5-fold greater odds for high health care costs (OR, 6.08 [95% CI, 4.99-7.41]), and those with stage IV cancer had 8-fold greater odds for high health care costs (OR, 8.94 [95% CI, 7.43-10.80]). Receiving multiple treatment modalities also was associated with greater odds for high-cost care.

CONCLUSIONS AND RELEVANCE

This cohort study found that more advanced disease stage and receiving multiple treatment modalities were the strongest predictors of high-cost care among patients diagnosed with head and neck cancer. Prioritizing research and implementation of screening programs, earlier cancer diagnoses, and effective treatment deescalation strategies might mitigate a significant portion of these high costs.