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Article Title

Long-Term Medical Care Costs of Breast, Prostate, Lung and Colorectal Cancer for HMO Members

Publication Date

4-30-2015

Keywords

cost of care, cancer

Abstract

Background/Aims: The rising economic burden of cancer in the United States has become a significant public policy issue. Current knowledge of cancer care costs is largely limited to Medicare fee-for-service patients age ≥ 65 years, based on linked Surveillance, Epidemiology, and End Results (SEER) Medicare data. Accordingly, estimates that reflect care costs across the cancer experience, from diagnosis to end-of-life and among individuals < 65 years of age, are needed. This study estimated total and incremental long-term costs of care for individuals age ≥ 18 years diagnosed with breast, colorectal, lung and prostate cancer in integrated health care settings.

Methods: We used administrative and electronic medical record data linked with tumor registry information for individuals who were enrolled in one of four nonprofit integrated health care systems and diagnosed with primary breast, colorectal, lung or prostate cancer between 1/1/2000–12/31/2008 (cases). We also identified age-/sex-matched cancer-free individuals (controls). Participating health systems included Group Health Cooperative, Henry Ford Health System, Kaiser Permanente Northwest and Kaiser Permanent Colorado. Long-term costs (at 5, 10 and 20 years) of care were based on the Phases-of-Care approach (Initial, Continuing and End-of-life phases) and measured using the Kaplan-Meier Sample Average estimator, incorporating cost data from the standardized relative resource cost algorithm and cancer site-, age- and stage-specific survival probabilities from SEER. Costs were calculated for both cases and controls to estimate total and incremental care costs, stratified by cancer site, age group (≥65 years) and stage at diagnosis (advanced vs. not advanced).

Results: Total and incremental long-term costs of cancer care were significantly higher among individuals age < 65 years at diagnosis compared to those ≥ 65 years. There was considerable variability in total and incremental long-term costs by cancer site and stage at diagnosis.

Discussion: Estimates reported in this study improve our understanding of the magnitude of long-term economic resources needed to provide cancer care in the United States by describing cancer care costs among patients in integrated care settings and those age < 65 years. Our results will be directly applicable to future analyses of cancer care costs, serving as a foundation for cost comparisons across different health care systems.

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