Villemure-Poliquin Noémie, Fu Rui, Li Qing, Ayoo Kennedy, Chan Kelvin K W, Karam Irene, Wright Frances C, Coburn Natalie G, Hallet Julie, Eskander Antoine
Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
JAMA Otolaryngol Head Neck Surg. 2025 Jul 17. doi: 10.1001/jamaoto.2025.1976.
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.
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.
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.
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.
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.
一小部分患者的护理占据了医疗保健支出中不成比例的很大一部分。由于治疗方案复杂且存在长期后遗症，头颈癌与高昂的医疗保健成本相关。鉴于这种高昂的基线成本，在癌症患者群体中识别出医疗成本高的患者可能有助于为优化资源分配的干预措施提供信息。
描述头颈癌患者在诊断后第一年医疗保健成本最高的特征。
设计、设置和参与者：一项基于人群的回顾性队列研究，使用了加拿大安大略省临床和评价科学研究所的行政数据，纳入了2007年1月至2020年10月期间被诊断为头颈癌的成年人（从省级癌症登记处识别），从诊断日期到死亡日期或2021年10月31日进行了整整1.5年的随访。使用患者层面的算法估算了1年的总医疗保健成本，并以2020年加拿大元的价值进行收集。主要分析于2023年4月进行，敏感性分析于2025年4月进行。
头颈癌诊断后第一年的高医疗保健成本（>第75百分位数）。使用多变量逻辑回归模型确定高医疗保健成本的预测因素。
该队列包括13795名患者（平均年龄63.2[标准差，11.7]岁，3452名[25.0%]为女性），其中3448名（25%）医疗保健成本高。癌症分期是高医疗保健成本的最强预测因素。与I期癌症患者相比，II期癌症患者高医疗保健成本的几率高2倍（优势比[OR]，3.14[95%置信区间，2.56 - 3.84]），III期癌症患者高医疗保健成本的几率高5倍（OR，6.08[95%置信区间，4.99 - 7.41]），IV期癌症患者高医疗保健成本的几率高8倍（OR，8.94[95%置信区间，7.43 - 10.80]）。接受多种治疗方式也与高成本护理的几率增加有关。
这项队列研究发现，疾病分期越晚和接受多种治疗方式是头颈癌患者高成本护理的最强预测因素。优先开展筛查项目的研究和实施、更早的癌症诊断以及有效的治疗降级策略可能会降低这些高昂成本的很大一部分。
