The cost of oral cancer: A systematic review

Abstract

Although clinical and epidemiological aspects of oral cancers (OC) are well-documented in the literature, there is a lack of evidence on the economic burden of OC. This study aims to provide a comprehensive systematic assessment on the economic burden of OC based on available evidence worldwide. A systematic review was conducted. The population was any individual, who were exposed to OC, considered here as lip (LC), oral cavity (OCC), or oropharynx (OPC) cancer. The outcome was information on direct (medical and non-medical) and indirect (productivity loss and early death) costs. The data sources included Scopus, Web of Science, Cochrane, BVS, and NHS EED. A search of grey literature (ISPOR and INAHTA proceedings) and a manual search in the reference lists of the included publications were performed (PROSPERO no. CRD42020172471). We identified 24 studies from 2001 to 2021, distributed by 15 countries, in 4 continents. In some developed western countries, the costs of LC, OCC, and OPC reached an average of Gross Domestic Product per capita of 18%, 75%, and 127%, respectively. Inpatient costs for OC and LC were 968% and 384% higher than those for outpatients, respectively. Advanced cancer staging was more costly (from ~22% to 373%) than the early cancer staging. The economic burden of oral cancer is substantial, though underestimated.

Fig 1. Data acquisition flowchart.

Fig 2

Oral cancer burden of cost and difference of costs (%) according to types of patient care (A) and clinical stage of the disease (B). Difference (%) = [(inpatient cost–outpatient cost)/outpatient cost x 100]. Currency: Kim,2011: Pounds; Lairson, 2017, Rezapour, 2018, Amarasinghe, 2019, Zavras, 2002, Epstein, 2008: US dollars; Pollaers, 2019: Australian dollars; Lafuma, 2019: Euros; Milani, 2021: International dollars (million); Goyal, 2014: rupees.