Prevalence, Economic Burden, and Healthcare Utilization among Medicare and Commercially Insured Patients with...

Oropharyngeal and oral cancers (OOC) represent a growing public health concern with significant long-term health and economic consequences. This study evaluated risk-adjusted dental utilization patterns and associated healthcare costs among patients with OOC in Medicare and commercially insured populations.

Using the 2013 to 2024 Merative MarketScan Research Databases, individuals with at least one medical claim for OOC were identified and matched 1:1 to non-OOC controls using propensity score matching. Analyses were stratified by insurance type (Medicare vs. commercial). Outcomes included frequency of dental visits, types of dental procedures, treatment modalities, and total annual healthcare costs.

The prevalence of OOC was 67 per 100,000 among commercially insured and 397 per 100,000 among Medicare enrollees. Compared with controls, patients with OOC were older and predominantly male (all P < 0.01). Patients with OOC had significantly fewer annual dental visits than controls [2.79 vs. 2.98 (Medicare); 2.81 vs. 3.20 (commercial), all P < 0.0001]. Restoration and periodontal treatments were the most common dental procedures. Surgical treatment alone was more frequent among patients with OOC (20.1% Medicare; 15.6% commercial). The risk-adjusted total annual healthcare burden was $22,984 for Medicare and $47,542 for commercial patients with OOC (P < 0.001).

Despite higher medical costs and intensive cancer treatment, patients with OOC had fewer dental visits, indicating a gap in survivorship care.

These findings highlight the urgent need for integrated medical-dental care models and policies that enhance access to preventive and restorative dental services, potentially reducing complications, improving quality of life, and lowering healthcare costs among OOC survivors.