Comparing Treatment-related Costs of Oral Tongue Squamous Cell Carcinoma Among Commercially Insured Adults

Introduction: Oral tongue squamous cell carcinoma (OTSCC) incidence is rising in younger adults, who may face disproportionate financial burden. We evaluated age-associated differences in out-of-pocket (OOP) costs across treatment phases among insured patients.

Methods: This retrospective cohort study used the MarketScan claims database to assess adults (age < 18) with OTSCC undergoing glossectomy from 2007 to 2023. Claims were partitioned into diagnostic (90 days pre-surgery), perioperative (surgery to follow-up), adjuvant (post-surgery radiation/chemotherapy, if applicable), and surveillance phases (post-treatment to 180 days). Treatment OOP combined perioperative and adjuvant costs. We compared younger ( < 50) and older patients (50-64) using Wilcoxon tests, multivariable log-linear regression, and Firth penalized logistic regression.

Results: Among 3446 patients, younger patients (n=1008) had higher median treatment OOP costs ($2701[IQR $678–11900] vs $1364 [IQR$504–6835];p < 0.001) and median total reimbursed healthcare spending ($47494[IQR $504-6835] vs $41712[IQR $678-11900]; p< 0.001) compared to older patients (n=2438). In models adjusted for sex, region, and insurance, younger patients had 94.7% higher treatment OOP costs (95%CI 59.9–137.1%; p< 0.001), even after adjustment for treatment modality (surgery alone, surgery + radiation, surgery + chemotherapy, or surgery + radiation + chemotherapy; 102.0% higher; 95%CI 67.9–143.1%; p< 0.001). Younger patients had higher odds of top decile treatment OOP spending (OR 1.38; 95%CI 1.03–1.84; p=0.034) but lower perioperative ($474 vs $1218 [95%CI $-952, -525]; p< 0.001) and surveillance ($72 vs $780;[95%CI $-872,$-599];p < 0.001) OOP costs compared to older patients.

Conclusions: Commercially insured younger adults undergoing OTSCC surgery experienced higher treatment-period OOP spending, indicating disparate age-based financial burdens.