Oral Cancer Prevalence, Mortality, and Costs in Medicaid and Commercial Insurance Claims Data

• Published in: Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2022-09, Vol.31 (9), p.1849-1857
• Main Authors: Tranby, Eric P, Heaton, Lisa J, Tomar, Scott L, Kelly, Abigail L, Fager, Gulielma Leonard, Backley, Mary, Frantsve-Hawley, Julie
• Format: Article
• Language: English
• Subjects: Adult; Health Care Costs; Humans; Insurance, Health; Male; Medicaid; Mouth Neoplasms - epidemiology; Mouth Neoplasms - therapy; Oropharyngeal Neoplasms; Prevalence; Retrospective Studies; United States - epidemiology
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.EPI-22-0114

This study compared prevalence, incidence, mortality rates, treatment costs, and risk factors for oral and oropharyngeal cancer (OC/OPC) between two large United States adult cohorts in 2012-2019. Medicaid and commercial claims data came from the IBM Watson Health MarketScan Database. Logistic regression analyses estimated incidence and risk factors for OC/OPC. Mortality was calculated by merging deceased individuals' files with those of the existing cancer cohort. Summing costs of outpatient and inpatient services determined costs. Prevalence of OC/OPC in Medicaid enrollees decreased each year (129.8 cases per 100,000 enrollees in 2012 to 88.5 in 2019); commercial enrollees showed a lower, more stable prevalence (64.7 per 100,000 in 2012 and 2019). Incidence trended downward in both cohorts, with higher incidence in the Medicaid (51.4-37.6 cases per 100,000) than the commercial cohort (31.9-31.0 per 100,000). Mortality rates decreased for Medicaid enrollees during 2012-2014 but increased in the commercial cohort. OC/OPC treatment costs were higher for commercial enrollees by $8.6 million during 2016-2019. OC/OPC incidence was higher among adults who were older, male, and white; used tobacco or alcohol; or had prior human immunodeficiency virus/acquired immune deficiency syndrome diagnosis and lower among those who had seen a dentist the prior year. Medicaid enrollees experienced higher OC/OPC incidence, prevalence, and mortality compared with commercially insured adults. Having seen a dentist within the prior year was associated with a lower risk of OC/OPC diagnosis. Expanding Medicaid dental benefits may allow OC/OPC to be diagnosed at earlier stages through regular dental visits.