Patterns of Medical Care Cost by Service Type for Patients With Recurrent and De Novo Advanced Cancer

6611 Background: To address the paucity of data on costs of cancer recurrence, this study estimated medical care costs of patients diagnosed with recurrent breast, colorectal or lung cancer, and compared costs to patients diagnosed with de novo stage IV disease. Methods: Data from patients enrolled in three health plans who were diagnosed with de novo stage IV or recurrent breast (nstage IV = 352; nrecurrent= 765), colorectal (nstage IV = 1072 and nrecurrent= 542) and lung (nstage IV = 4042 and nrecurrent= 339) cancers between 2000-2012 were used to estimate total medical care costs in the 12 months preceding (pre-index), month of index, and 12 months following (post-index) diagnosis/recurrence date. Cancer patients were identified using tumor registry data. Recurrent cancers were validated by medical record abstraction and the RECUR algorithms –innovative tools to detect recurrence using claims and electronic health record data. We used generalized linear repeated measures regression models controlling for demographic and comorbidity variables to estimate costs (2012 US$), stratified by age at diagnosis (ages < 65, ≥65). Results: Medical care cost differences in the pre-index period indicate higher costs for recurrent cancer patients than for stage IV breast (Age < 65:+$2550; Age ≥65: +$1254), colorectal (Age < 65:+$3295; Age ≥65: +$1653), and lung cancer patients (Age < 65:+$3232; Age ≥65: +$2340). Conversely, in the index and post-index periods, costs for stage IV cancers were higher than recurrent cancer costs. Specifically, post-index period cost differences indicate higher costs for stage IV patients than for recurrent breast (Age < 65:+$683; Age ≥65: +$1172), colorectal (Age < 65:+$3104; Age ≥65: +$1557), and lung cancer patients (Age < 65:+$1136; Age ≥65: +$1103). Conclusions: Our study provides medical care cost estimates of recurrent and de novo stage IV cancers. Cost differences between recurrent and stage IV cancers reveal heterogeneity in care patterns that merits further investigation. The reported study costs, measured in capitated care systems using standardized fee-for-service reimbursement coefficients, may serve as a benchmark for stage-specific phase-of-care oncology episode payment models.

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Average medical cost of fatal and non-fatal injuries by type in the USA

Injury Prevention ◽

10.1136/injuryprev-2019-043544 ◽

2019 ◽

pp. injuryprev-2019-043544 ◽

Cited By ~ 1

Author(s):

Cora Peterson ◽

Likang Xu ◽

Curtis Florence

Keyword(s):

Medical Care ◽

Medical Cost ◽

Cost Effective ◽

Medical Care Cost ◽

Body Region ◽

Injury Type ◽

Inpatient Settings ◽

The Usa ◽

Multivariable Regression ◽

Fatal Injuries

ObjectiveTo estimate the average medical care cost of fatal and non-fatal injuries in the USA comprehensively by injury type.MethodsThe attributable cost of injuries was estimated by mechanism (eg, fall), intent (eg, unintentional), body region (eg, head and neck) and nature of injury (eg, fracture) among patients injured from 1 October 2014 to 30 September 2015. The cost of fatal injuries was the multivariable regression-adjusted average among patients who died in hospital emergency departments (EDs) or inpatient settings as reported in the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample, controlling for demographic (eg, age), clinical (eg, comorbidities) and health insurance (eg, Medicaid) factors. The 1-year attributable cost of non-fatal injuries was assessed among patients with ED-treated injuries using MarketScan medical claims data. Multivariable regression models compared total medical payments (inpatient, outpatient, drugs) among non-fatal injury patients versus matched controls during the year following injury patients’ ED visit, controlling for demographic, clinical and insurance factors. All costs are 2015 US dollars.ResultsThe average medical cost of all fatal injuries was approximately $6880 and $41 570 per ED-based and hospital-based patient, respectively (range by injury type: $4764–$10 289 and $31 912–$95 295). The average attributable 1-year cost of all non-fatal injuries per person initially treated in an ED was approximately $6620 (range by injury type: $1698–$80 172).Conclusions and relevanceInjuries are costly and preventable. Accurate estimates of attributable medical care costs are important to monitor the economic burden of injuries and help to prioritise cost-effective public health prevention activities.

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Medical Care Cost of Medicare/Medicaid Beneficiaries with Vision Loss

Ophthalmic Epidemiology ◽

10.1080/09286580802523107 ◽

2009 ◽

Vol 16 (1) ◽

pp. 50-57 ◽

Cited By ~ 5

Author(s):

Alan R. Morse ◽

Bruce S. Pyenson

Keyword(s):

Medical Care ◽

Vision Loss ◽

Medical Care Cost ◽

Medicaid Beneficiaries

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Updated medical care cost estimates for HPV-associated cancers: implications for cost-effectiveness analyses of HPV vaccination in the United States

Human Vaccines & Immunotherapeutics ◽

10.1080/21645515.2019.1603562 ◽

2019 ◽

Vol 15 (7-8) ◽

pp. 1942-1948 ◽

Cited By ~ 2

Author(s):

Harrell W. Chesson ◽

Elissa Meites ◽

Donatus U. Ekwueme ◽

Mona Saraiya ◽

Lauri E. Markowitz

Keyword(s):

United States ◽

Cost Effectiveness ◽

Medical Care ◽

Hpv Vaccination ◽

The United States ◽

Medical Care Cost ◽

Cost Estimates

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Why Does Medical Care Cost So Much?

New England Journal of Medicine ◽

10.1056/nejm197006252822605 ◽

1970 ◽

Vol 282 (26) ◽

pp. 1458-1465 ◽

Cited By ~ 12

Author(s):

Walter J. McNerney

Keyword(s):

Medical Care ◽

Medical Care Cost

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Spending for Advanced Cancer Diagnoses: Comparing Recurrent Versus De Novo Stage IV Disease

Journal of Oncology Practice ◽

10.1200/jop.19.00004 ◽

2019 ◽

Vol 15 (7) ◽

pp. e616-e627 ◽

Cited By ~ 1

Author(s):

Michael J. Hassett ◽

Matthew Banegas ◽

Hajime Uno ◽

Shicheng Weng ◽

Angel M. Cronin ◽

...

Keyword(s):

Advanced Cancer ◽

Cancer Diagnosis ◽

De Novo ◽

Stage Iv ◽

Absolute Difference ◽

Medicare Data ◽

Stage Iv Disease ◽

De Novo Cancer ◽

Payment Models ◽

Diagnosis Age

PURPOSE: Spending for patients with advanced cancer is substantial. Past efforts to characterize this spending usually have not included patients with recurrence (who may differ from those with de novo stage IV disease) or described which services drive spending. METHODS: Using SEER-Medicare data from 2008 to 2013, we identified patients with breast, colorectal, and lung cancer with either de novo stage IV or recurrent advanced cancer. Mean spending/patient/month (2012 US dollars) was estimated from 12 months before to 11 months after diagnosis for all services and by the type of service. We describe the absolute difference in mean monthly spending for de novo versus recurrent patients, and we estimate differences after controlling for type of advanced cancer, year of diagnosis, age, sex, comorbidity, and other factors. RESULTS: We identified 54,982 patients with advanced cancer. Before diagnosis, mean monthly spending was higher for recurrent patients (absolute difference: breast, $1,412; colorectal, $3,002; lung, $2,805; all P < .001), whereas after the diagnosis, it was higher for de novo patients (absolute difference: breast, $2,443; colorectal, $4,844; lung, $2,356; all P < .001). Spending differences were driven by inpatient, physician, and hospice services. Across the 2-year period around the advanced cancer diagnosis, adjusted mean monthly spending was higher for de novo versus recurrent patients (spending ratio: breast, 2.39 [95% CI, 2.05 to 2.77]; colorectal, 2.64 [95% CI, 2.31 to 3.01]; lung, 1.46 [95% CI, 1.30 to 1.65]). CONCLUSION: Spending for de novo cancer was greater than spending for recurrent advanced cancer. Understanding the patterns and drivers of spending is necessary to design alternative payment models and to improve value.

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