3742 - Costs of Surveillance Care after Definitive Treatment of Head and Neck Cancer: A SEER-Medicare Analysis

Purpose/Objective(s): Following curative treatment of squamous carcinoma of the head and neck, surveillance care is indicated to detect recurrence. Historically, physical exam is the backbone of surveillance, but many cases require serial imaging and flexible endoscopy for evaluation. Recently, assays have become commercially available which are more effective at recurrence detection. To understand the potential economic impact of these assays, baseline of surveillance costs must be established. We performed a SEER-Medicare analysis to quantify the costs of classic surveillance procedures.

Materials/Methods: After IRB approval, we 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 enrolled in Medicare Advantage. The surveillance period was defined from 2 months past treatment through the date of death, hospice enrollment, or additional cancer treatments. Procedures likely 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.

Results: In total, 13,339 pts were identified; all were age =65. The most common site was oropharynx (OPC), followed by oral cavity. Of the OPC patients, 33% were 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. Medicare spending on surveillance care and subsets is listed in the table. Surveillance was more expensive among younger, HPV+ OPC patients, and for those who followed longer. Flexible laryngoscopy was the most frequent charge.

Conclusion: In an older population, payer costs follow a wide and skewed distribution but are most 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.