Costs of Surveillance Care After Definitive Treatment of Head and Neck Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Medicare Analysis.

introductionFollowing curative treatment of squamous carcinoma of the head and neck, surveillance care is indicated to detect recurrence. Historically, physical exams are the backbone of surveillance, but serial imaging and flexible endoscopy are also utilized. Recently, assays have become commercially available, which could aid in early detection of recurrence. To understand the potential economic impact of these assays, a baseline of surveillance costs must be established. We performed a Surveillance, Epidemiology, and End Results (SEER)-Medicare analysis to quantify the costs of classic surveillance procedures. MATERIALS AND

methodsWe obtained data from the 2010-2017 SEER program linked to traditional Medicare Part A & B claims and enrollment information dating 2010-2019. Patients with non-metastatic cancers of the head and neck, including oral cavity, paranasal sinus, pharynx, and larynx, were identified. Definitive treatment with either surgery or radiation therapy (with or without systemic therapy) was required for inclusion. Patients were excluded if they had any lapse in insurance coverage (i.e., Parts A & B) or were enrolled in Medicare Advantage. The surveillance period was defined from 90 days past treatment through the date of death, hospice enrollment, or additional cancer treatments. Procedures related to routine surveillance were identified, including flexible endoscopy and imaging. The cumulative Medicare spend was quantified, adjusting for inflation to 2021 U.S. dollars.

resultsIn total, 13,339 patients were identified; all were age ≥ 65. The most common site was the oropharynx (OPC), followed by larynx cancers. Of the OPC patients, 33% were human papillomavirus positive (HPV+), and for 55%, the HPV status was unknown. The median clinical follow-up was 43.0 months, and the median surveillance period was 16.6 months. The median costs were $1,246 (IQR $420-$2,381), with the top 5% incurring a cost of $7,657 (IQR $6,656-9,062). Surveillance was more expensive among younger, HPV+ OPC patients and for those who followed longer. Flexible laryngoscopy was the most frequent charge.

conclusionsIn an older population, payer costs follow a wide and skewed distribution but are highest among younger HPV+ OPC patients. These findings facilitate cost-effectiveness assessment of novel assays. Opportunity exists to reduce imaging and endoscopy spend by substituting more accurate biomarkers.