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Findings From Linked SEER-Medicare Data

Kathleen Lang, PhD; Joseph Menzin, PhD; Craig C. Earle, MD; Jerilynn Jacobson, MA; Ming-Ann Hsu, MPH

Arch Otolaryngol Head Neck Surg. 2004;130:1269-1275.

Objective  To evaluate the excess mortality, resource use, and costs associated with squamous cell carcinoma of the head and neck (SCCHN) among elderly Medicare beneficiaries.

Design  Retrospective cohort analysis using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute and Medicare claims.

Subjects  Study cohorts included patients aged 65 years and older who were newly diagnosed as having SCCHN in a SEER registry between 1991 and 1993 (N = 4536) and controls matched 1:1 by age and sex. Patients were followed up for 5 years or until death, whichever occurred first.

Results  Initial treatment was primarily surgery and/or radiation among patients with early-stage SCCHN, with only modest use of chemotherapy. Patients with SCCHN had significantly (P<.001) higher 5-year mortality (64% vs 25%) and health care costs than controls. Average Medicare payments (1998 US dollars) among patients with SCCHN were $25 542 higher than those of matched comparison patients (P<.001), with monthly payments 3 times as high ($1428 vs $446). Patients diagnosed as having advanced SCCHN had shorter survival times (5-year mortality, 85%, 75%, 47%, and 35% among patients diagnosed as having distant, regional, local, and in situ cancer, respectively) and higher costs (average total Medicare payments, $53 741, $58 387, $42 698, and $37 434, respectively).

Conclusion  These results suggest that the health economic burden of SCCHN is substantial, with costs that are comparable with or higher than those of other solid tumors.

Author Affiliations: Boston Health Economics Inc, Waltham, Mass (Drs Lang and Menzin); Dana-Farber Cancer Institute, Boston, Mass (Dr Earle); Wyeth Pharmaceuticals, Cambridge, Mass (Ms Jacobson); and Pfizer Inc, Groton, Conn (Ms Hsu).

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