Open Access Open Badges Research

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, medicare, and medicaid

Jed J Jacobson1*, Joel B Epstein2, Frederick C Eichmiller3, Teresa B Gibson4, Ginger S Carls4, Emily Vogtmann5, Shaohung Wang6 and Barbara Murphy7

Author Affiliations

1 Delta Dental of Michigan, University of Michigan, 4100 Okemos Road, Okemos, MI, 48864, USA

2 University of Illinois at Chicago, 1500 East Duarte Road, Duarte, CA, 91019-3000, USA

3 Delta Dental of Wisconsin, 2801 Hoover Road, Stevens Point, WI, 54481, USA

4 Thomson Reuters, 777 East Eisenhower Parkway, Ann Arbor, MI, 48108, USA

5 Department of Epidemiology, Thomson Reuters, RPHB, 1530 3rd Avenue South, Birmingham, AL, 35294-0022, USA

6 Formerly of Thomson Reuters, 15 Crescent Road, Lexington, MA, 02421, USA

7 Vanderbilt University, 2220 Pierce Avenue, 777 PRB, Nashville, TN, 37232-6307, USA

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Head & Neck Oncology 2012, 4:15  doi:10.1186/1758-3284-4-15

PUBLISHER'S NOTE: Based on the information available to BioMed Central, this article was apparently handled and peer reviewed only by Waseem Jerjes, an Editor-in-Chief of the journal at that time. There were no other peer reviewers and the manuscript was accepted without revision.

Published: 26 April 2012



Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated.


A retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients.


Total annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees (p < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population.


In the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.

Oral cancer; Cost-burden; Cost of illness; Burden of illness