Background: This study examines trends in the Department of Defense (DoD) beneficiary population diagnosed with head and neck cancer (HNC) with respect to: (1) reimbursed annual costs, and (2) patterns and predictors of healthcare utilization in military and civilian systems of care.
Methods: Administrative claims data from the Military Health System Data Repository were analyzed to identify beneficiaries, age 18 – 64, with a principle ICD-9 diagnosis of HNC, fiscal years 2007 - 2014. Total cost, number of ambulatory visits, and number of hospitalizations with subsequent number of admission days were analyzed. Independent variables included fiscal year, demographic variables (age group, sex, rank of sponsor, military service affiliation), beneficiary status (active duty, family member, military retiree, family member of military retiree), type and geographic region of TRICARE enrollment, system of care (military, purchased civilian health care, combined), cancer treatment modality (surgery, radiation, chemotherapy), physical and mental health comorbid conditions, and tobacco use.
Results: We identified approximately 3,000 beneficiaries with HNC diagnosed annually. 62% were between age 55-64, 70% were male, and 78% had enlisted rank sponsorship. Adjusted to 2014 dollars, the average annual cost per patient excluding pharmacy costs was $16,607 with average annual pharmacy cost of $3,749. Bivariate analysis also showed no statistically significant difference in total cost or pharmacy cost between fiscal years; bivariate analysis also showed no statistically significant difference in healthcare utilization between fiscal years. Beneficiaries who received care in both military and civilian facilities had significantly higher costs (p < 0.001) than those treated in one system of care exclusively. There was no statistically significant difference, however, in annual total cost of care was found between those treated exclusively in either system of care. By annual average, the number of ambulatory visits was 30.44, the number of hospital admissions was 1.65, and the number of admission days was 20.76. The five biggest predictors of healthcare utilization outcomes were (1) chemotherapy (p < 0.0001), (2) the presence of a mood disorder comorbidity, (3) radiation therapy, and (4) surgical resection p < 0.0001), and (5) number of chronic physical health conditions (p < 0.0001).
Conclusions: TRICARE is the military’s single-payer healthcare system, covering active duty and retired military servicemembers, as well as their families. This is the first study to analyze cost and healthcare utilization of non-elderly adults with head and neck cancer. The average annual costs of non-elderly beneficiaries diagnosed with head and neck cancer were found to be lower than those reported using data from the Medical Expenditure Panel Survey, which included all ages ($23,408). Further, cost burden under TRICARE claims did not demonstrate a significant difference whether they were treated within military or civilian networks alone. These data can help determine both cost and personnel needed to support a defined incidence of HNC. Primary prevention of HNC in the face of a stable annual incidence include tobacco and heavy alcohol use identification and cessation, and offering of HPV vaccination administration for servicemembers per CDC guidelines.