COST-IDENTIFICATION ANALYSIS IN ORAL CAVITY CANCER MANAGEMENT

The objectives of this study were to investigate potential relationshi ps between pretreatment patient-mix characteristics, treatment modalit ies, and costs generated during the pretreatment work-up, treatment, a nd I-year follow-up periods for patients with oral cavity cancer (OCC) . Another objective was to identify potential areas for cost reduction and improved resource allocation in the management of OCC patients. U sing a retrospective cohort of 73 patients with OCC, pretreatment pati ent-mix characteristics and treatment modalities were evaluated in rel ation to university-based charges incurred during the pretreatment eva luation, treatment, and I-year follow-up periods. Simple regression an d stepwise multiple regression analyses were used to develop predictiv e models for cost based on independent variables, including age, AJCC TNM clinical stage, smoking history, American Society of Anesthesiolog ists (ASA) class, comorbidity as defined by the Kaplan-Feinstein grade and treatment modality The dependent measurements included all physic ian, office, and hospital charges incurred at the University of Iowa H ospitals and Clinics during the pretreatment evaluation, treatment, an d follow-up periods, as well as the total pretreatment through I-year follow-up management costs. Independent variables that were identified as being significantly associated with treatment costs included T cla ssification, N classification, TNM stage, unimodality versus multimoda lity treatment, and the Kaplan-Feinstein comorbidity grade. Age, smoki ng status, and ASA class were not significantly associated with costs. The majority of the OCC management costs were incurred during the tre atment period. The most substantial decreases in management costs for OCC will be realized through measures that allow identification and tr eatment of disease at an early stage, in which single-modality treatme nt may effectively be used. Resource allocation for OCC should support the investigation of measures through which the diagnosis and treatme nt of OCC at the earliest possible stage is facilitated. The presence of comorbid illness is a significant component in the determination of management costs for OCC and should be included in analyses of resour ce allocation for OCC. The singular diagnosis of OCC encompasses a wid e range of patient illness severity, and diagnosis-related reimburseme nt schemes for OCC treatment should optimally differentiate between ea rly and advanced stage disease.