Lifetime economic burden of oropharyngeal cancer: The role of comorbidities in older adults.

24 Background: Oropharyngeal cancer (OPC) incidence is rising rapidly—over 4%/year—among older adults. Comorbid health conditions are more common among older adults and can worsen clinical and economic outcomes. However, the impact of comorbidities on cost among the growing population of older adults with OPC is poorly understood. Methods: Using the 2000–2019 SEER-Medicare database, we estimated lifetime and phase-specific care costs for older adults diagnosed with OPC, stratified by comorbidity burden. We identified patients aged ≥66 years with a first primary diagnosis of OPC and assessed comorbidity burden using the Charlson-Deyo Comorbidity Index (CDCI). To estimate per-person per-month cancer-related (excess) medical costs—defined as incremental costs compared to non-cancer control—patients were matched 1:1 to cancer-free Medicare beneficiaries based on age, sex, and geographic region. Costs were calculated by comorbidity burden over the lifetime and across three care phases: (1) initial phase (first 6 months after diagnosis), (2) continuation phase, and (3) terminal phase (last 12 months). We estimated 95% confidence intervals (CI) using bootstrapping with 10,000 resamples. Results: The final cohort included 9,670 HPV-OPC patients [mean age of 73.1±6.0 years; 76% male; 86% non-Hispanic White]. The excess lifetime cost of OPC, compared to a matched non-cancer cohort, was estimated at $148,073 per person (2024 USD; 95% CI: $145,334–$150,901). Costs increased with comorbidity burden, ranging from $100,050 (95% CI: $93,907–$105,743) for individuals with a CDCI score of 0 to $172,325 (95% CI: $160,072–$184,008) for those with a score >3. This pattern persisted across care phases: initial phase costs rose from $10,228 (95% CI: $9,586–$10,840) to $11,768 (95% CI: $10,925–$12,549), continuation phase costs from $167 (95% CI: $157–$178) to $1,090 (95% CI: $1,012–$1,170), and terminal phase costs from $1,842 (95% CI: $1,114–$2,552) to $4,342 (95% CI: $2,427–$6,374) as comorbidity burden increased. Conclusions: These findings highlight the substantial cost burden of higher comorbidity in older adults with OPC across all phases of care. Excess lifetime and phase-specific monthly costs of OPC vs. matched non-cancer cohort (2024 USD, per person). Lifetime Phase-specific costs (per person per month) (per person) Initial Continuation Terminal All $148,073($145,334 - $150,901) $10,801($10,612 - $11,004) $619($608 - $630) $3,030($2,673 - $3,381) Comorbidity burden 0 $100,050($93,907 - $105,743) $10,228($9,586 - $10,840) $167($157 - $178) $1,842($1,114 - $2,552) 1 $127,249($117,667 - $137,556) $10,437($9,690 - $11,207) $468($433 - $506) $2,438($1,216 - $3,652) 2-3 $156,731($142,829 - $171,323) $11,083($10,099 - $12,185) $750($679 - $819) $3,526($1,403 - $5,779) 3+ $172,325($160,072 - $184,008) $11,768($10,925 - $12,549) $1,090($1,012 - $1,170) $4,342($2,427 - $6,374)