scholarly journals Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer

2015 ◽  
Vol 33 (36) ◽  
pp. 4259-4267 ◽  
Author(s):  
Andrew J. Epstein ◽  
Yu-Ning Wong ◽  
Nandita Mitra ◽  
Anil Vachani ◽  
Sakhena Hin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Adjuvant Chemotherapy ◽  
Health Care Costs ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Administrative Claims ◽  
Medical Spending ◽  
The Impact ◽  
Care Costs

Purpose We assessed the associations between the 21-gene recurrence score assay (RS) receipt, subsequent chemotherapy use, and medical expenditures among patients with early-stage breast cancer. Patients and Methods Data from the Pennsylvania Cancer Registry were used to assemble a retrospective cohort of women with early-stage breast cancer from 2007 to 2010 who underwent initial surgical treatment. These data were merged with administrative claims from the 12-month periods before and after diagnosis to identify comorbidities, treatments, and expenditures (n = 7,287). Propensity score–weighted regression models were estimated to identify the effects of RS receipt on chemotherapy use and medical spending in the year after diagnosis. Results The associations between RS receipt and outcomes varied markedly by patient age. RS use was associated with lower chemotherapy use among women younger than 55 (19.2% lower; 95% CI, 10.6 to 27.9). RS use was associated with higher chemotherapy use among women 75 to 84 years old (5.7% higher; 95% CI, 0.4 to 11.0). RS receipt was associated with lower adjusted 1-year medical spending among women younger than 55 ($15,333 lower; 95% CI, $2,841 to $27,824) and with higher spending among women who were 75 to 84 years old ($3,489 higher; 95% CI, $857 to $6,122). Conclusion RS receipt was associated with reduced use of adjuvant chemotherapy and lower health care spending among women with breast cancer who were younger than 55. Conversely, among women 75 and older, RS testing was associated with a modest increase in chemotherapy use and slightly higher spending. From a population perspective, the impact of RS testing on breast cancer treatment and health care costs is much greater in younger women.

Impact of utilization management policy on uptake of hypofractionated radiation in early-stage breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7015-7015
Author(s):  
Winnie Chi ◽  
Ravi Bharat Parikh ◽  
Ezra Fishman ◽  
Robert Paul Zimmerman ◽  
Atul Gupta ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Early Stage Breast Cancer ◽  
Management Policy ◽  
Administrative Claims ◽  
Adult Women ◽  
Utilization Management ◽  
Hypofractionated Radiation ◽  
The Impact

7015 Background: While hypofractionated radiation (HFR) after breast-conserving surgery is a cost-effective, patient-centered treatment in early-stage breast cancer (ESBC), less than 40% of eligible women received it in 2013. In 2016, a large commercial payer implemented a utilization management policy to encourage HFR for eligible women through denying reimbursement for extended-course radiation. We assessed the impact of the policy on HFR use and associated spending. Methods: We conducted a retrospective, adjusted difference-in-differences analysis using administrative claims of women continuously enrolled in 14 geographically diverse commercial health plans covering 6.9% of US adult women. The study population included women aged 18 or older with ESBC who were eligible for HFR according to 2011 guidelines from the American Society for Radiation Oncology. Women who received mastectomy, brachytherapy, or < 11 or > 40 external beam fractions were excluded. We compared HFR use and associated spending between women in fully-insured and Medicare Advantage (fully-insured) plans for whom the policy applied vs. self-insured or Medicare supplemental insurance (self-insured) plans for whom the policy did not apply. We adjusted for age, comorbidity, region, Medicare enrollment, and prior chemotherapy. Results: Among 10,540 eligible women, 3,619 (34%) were in fully insured plans and thus subject to the policy. There were no meaningful differences in mean age (63.8 vs. 65.0), Charlson comorbidity index (3.0 vs. 3.2), or practice setting between the fully-insured and self-insured groups. The policy was associated with an increase in HFR (4.2 adjusted percentage point difference-in-difference [ppd], 95% CI 0.0 to 8.4, p = 0.051) and a non-significant decrease in radiotherapy-associated expenditures (-$2,275, p = 0.09). Spillover analyses revealed significantly higher uptake of HFR among self-insured patients who were indirectly exposed to the policy through seeing the providers who also treated fulled insured women (8.5 adjusted ppd, 95% CI 3.6 to 13.5, p = 0.001), compared to those who were not exposed. Conclusions: A payer’s utilization management policy was associated with direct and spillover increases in HFR use, even after accounting for a strong secular trend towards increased hypofractionation use. However, policymakers must balance the impact of this and similar policies against their additional administrative costs.

The Impact of Physical Activity on Mitigation of Health Care Costs Related to Diabetes Mellitus: Findings from Developed and Developing Settings

2016 ◽  
Vol 12 (4) ◽  
pp. 307-311 ◽  
Author(s):  
Bruna Camilo Turi ◽  
Henrique Luiz Monteiro ◽  
Rômulo Araújo Fernandes ◽  
Jamile Sanches Codogno
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care Costs ◽  
The Impact ◽  
Care Costs ◽  
Developing Settings

scholarly journals Institutionalization-Free Survival and Health Care Costs among Quebec Community-Dwelling Elderly Patients with Dementia

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Sarah-Gabrielle Beland ◽  
Antoine Pariente ◽  
Yola Moride
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Costs ◽  
Reference Population ◽  
Community Dwelling ◽  
Third Party ◽  
Published Data ◽  
Administrative Claims ◽  
Free Survival ◽  
Care Costs

Background. Published data on burden of dementia mainly include patients of third-care facilities. Economic consequences in an outpatient setting remain poorly examined. Objectives. To evaluate institutionalization-free survival and direct health care costs of dementia in the Quebec community-dwelling elderly population. Methods. A retrospective cohort study was conducted using the Quebec administrative claims databases. The cohort included a random sample of patients with treated dementia between January 1, 2000, and December 31, 2009 (n=37,138). The reference population included elderly patients without dementia matched in age group, gender, and index date. Using a third-party payer perspective, direct costs over 5 years were assessed. Results. Institutionalization-free survival at 5 years was lower in patients with dementia than in elderly without dementia (38.9% and 72.2%, resp.). Over 5 years, difference in mean total direct health care costs per patient was CAD$19,159, distributed into institutionalizations (CAD$13,598), hospitalizations (CAD$3,312), and prescribed medications (CAD$2,320). Costs of medical services were similar (−CAD$96). In the first year of followup, cost differentials were mainly attributable to hospitalizations, while in the last year (year 5) they were due to institutionalizations. Conclusion. This study confirms that dementia is an important socioeconomic burden in the community, the nature of which depends on disease progression.

The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model

2009 ◽  
Vol 117 (2) ◽  
pp. 401-408 ◽  
Author(s):  
G. H. de Bock ◽  
H. Putter ◽  
J. Bonnema ◽  
J. A. van der Hage ◽  
H. Bartelink ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Metastatic Progression ◽  
Multistate Model ◽  
The Impact
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