Journal of the National Cancer Institute Advance Access originally published online on April 29, 2008
JNCI Journal of the National Cancer Institute 2008 100(9):630-641; doi:10.1093/jnci/djn103
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Published by Oxford University Press 2008.
ARTICLES |
Cost of Care for Elderly Cancer Patients in the United States
Affiliations of authors: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY, A. Mariotto, JLW, MLB); Department of Health Care Policy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA (EBL); Information Management Systems, Inc, Rockville, MD (MT, A. Meekins)
Correspondence to: K. Robin Yabroff, PhD, MBA, Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Rm 4005, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344 (e-mail: yabroffr{at}mail.nih.gov)
Background: Timely estimates of the costs of care for cancer patients are an important element in the formulation of national cancer programs and policies. We estimated net costs of care for elderly cancer patients in the United States for the 18 most prevalent cancers and for all other tumor sites combined.
Methods: We used Surveillance, Epidemiology, and End Results–Medicare files to identify 718 907 cancer patients and 1 623 651 noncancer control subjects. Within each tumor site, noncancer control subjects were matched to patients by sex, age group, geographic location, and phase of care (ie, initial, continuing, and last year of life). Costs of care were estimated for each phase by use of Medicare claims data from January 1, 1999, through December 31, 2003. Per-patient net costs of care were applied to the 5-year survival of cancer patients by phase of care to estimate 5-year costs of care and extrapolated to the elderly US Medicare population diagnosed with cancer in 2004.
Results: Across tumor sites, mean net costs of care were highest in the initial and last year of life phases of care and lowest in the continuing phase. Mean 5-year net costs varied widely, from less than $20 000 for patients with breast cancer or melanoma of the skin to more than $40 000 for patients with brain or other nervous system, esophageal, gastric, or ovarian cancers or lymphoma. For elderly cancer patients diagnosed in 2004, aggregate 5-year net costs of care to Medicare were estimated to be approximately $21.1 billion. Costs to Medicare were highest for lung, colorectal, and prostate cancers, reflecting underlying incidence, stage distribution at diagnosis, survival, and phase-specific costs for these tumor sites.
Conclusions: The costs of cancer care to Medicare are substantial and vary by tumor site, phase of care, stage at diagnosis, and survival.
| CONTEXT AND CAVEATS Prior knowledge Timely estimates of the costs of care for cancer patients are an important element in the formulation of national cancer programs and policies. Study design Population-based study in which data from Surveillance, Epidemiology and End Results (SEER)–Medicare claims files were used to estimate net costs of care by phase of care (i.e., initial, continuing, and last year of life) from January 1, 1999, through December 31, 2003. These costs were then applied to survival data to estimate 5-year costs of care and extrapolated to newly diagnosed elderly cancer patients in 2004. Contribution The costs of cancer care to Medicare are substantial and vary by tumor site, phase of care, stage at diagnosis, and survival. Five-year costs to Medicare were highest for lung, colorectal, and prostate cancers. Implications These estimates represent a basis for projections of cancer costs that will be particularly important with the growth and aging of the US population. Limitations Incidence, survival, and costs of care were estimated from SEER and SEER–Medicare and assumed to be representative of the United States. Geographic variation may not be fully reflected in these estimates. Cost estimates did not include out-of-pocket expenses or co-payments and were based on the approximately 85% of Medicare enrollees in fee-for-service plans.
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The authors had full responsibility for the design of the study, the analysis and interpretation of the data, the decision to submit the manuscript for publication, and the writing of the manuscript.
Manuscript received September 20, 2007; revised February 21, 2008; accepted March 11, 2008.
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J Natl Cancer Inst 2008 100: 1413.
J Natl Cancer Inst 2008 100: 607-610.
J Natl Cancer Inst 2008 100: 603.
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