Head and neck cancers medical costs in a universal health system: a population-based case-control study

Importance — Head and neck cancers (HNC) impose a significant economic burden on healthcare systems. Understanding the direct medical costs across different phases of care is crucial for resource allocation and cost-effectiveness evaluations, particularly in universal healthcare settings.

Objective — To quantify the direct medical costs of HNC over 60 months postdiagnosis and examine cost variations by cancer subsite, stage, and treatment modality.

Design — Population-based, matched case–control study using administrative healthcare data.

Setting — Ontario, Canada, a province with a publicly funded universal healthcare system.

Participants — We included 19,832 adults diagnosed with HNC between 2007 and 2020. Each case was matched with 5 noncancer controls based on age, sex, and comorbidity.

Exposures — HNC diagnosis, categorized by cancer subsite, stage, and treatment modality.

Main outcome measures — Mean per-person direct medical costs attributable to HNC over a 63-month period, analyzed by phase of care, cancer subsite, stage, and treatment modality.

Results — The mean per-person cost attributable to HNC over 63 months was $53,812.9 ± $762.2. Costs peaked in the first 3 months postdiagnosis ($9709.7 ± $36.1 per month) and declined over time. Larynx/hypopharynx cancers incurred the highest costs across most phases. Advanced-stage cancers were associated with increased costs, with stage IV cancers nearly doubling the costs of stage I. Multimodal treatments, particularly surgery combined with chemoradiation, resulted in the highest costs across all phases (P < .01).

Conclusions — HNC results in substantial healthcare costs, with significant variations by subsite, stage, and treatment modality. The highest costs occur in the early treatment phase and remain elevated for patients requiring multimodal therapies.

Relevance — These findings provide critical data for policymakers and health system authorities to optimize resource allocation and assess cost-effectiveness. Future research should explore indirect costs and the impact of early detection strategies to reduce the economic burden of HNC.