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© The Author 2007. Published by Oxford University Press.
ARTICLE |
Patient Time Costs Associated With Cancer Care
Affiliations of authors: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY, WWD, MLB, JLW); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA (EBL); Information Management Systems, Inc, Rockville, MD (AF, MT)
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: Although costs of medical care for cancer have been investigated extensively, patient time costs associated with cancer care have rarely been estimated systematically. In this study, we estimated patient time costs associated with cancer care in patients aged 65 years and older in the United States.
METHODS: We identified 763 527 patients with breast, colorectal, corpus uteri, gastric, head and neck, lung, melanoma of the skin, ovary, prostate, renal, and urinary bladder cancers from linked Surveillance, Epidemiology, and End Results–Medicare files and 1 145 159 noncancer control subjects among Medicare enrollees who were matched by sex, age-group, and geographic location. Frequency of service use was calculated by category for patients and control subjects using Medicare claims data from 1995 to 2001. For each service category, time estimates were combined with service frequency and an hourly value of patient time. Net patient time costs were summed in the initial, continuing, and last-year-of-life phases of care for each tumor site. Net time cost estimates for the initial phase of care were applied to national estimates of numbers of new cancers in 2005 to obtain national time costs for the initial phase of care.
RESULTS: Net patient time costs during the initial phase of care ranged from $271 (95% confidence interval [CI] = $213 to $329) and $842 (95% CI = $806 to $878) for melanoma of the skin and prostate cancer, respectively, to $5348 (95% CI = $4978 to $5718) and $5605 (95% CI = $5273 to $5937) for gastric and ovarian cancers, respectively. Net patient time costs for care during the last year of life ranged from $1509 (95% CI = $1343 to $1675) for melanoma of the skin to $7799 (95% CI = $7433 to $8165), $7435 (95% CI = $7207 to $7663), and $7388 (95% CI = $7018 to $7758) for gastric, lung, and ovarian cancers, respectively. In 2005, patient time costs for the initial phase of care were $2.3 billion.
CONCLUSIONS: Patient time costs for cancer care in the United States are substantial and vary by tumor site and phase of care, likely reflecting differences in stage at diagnosis and availability and intensity of treatment.
| CONTEXT AND CAVEATS Prior knowledge Most estimates for costs of cancer care are based on costs of medical treatments. The costs associated with patient time spent travelling to and from care, waiting for, and receiving care are rarely reported. Study design Estimates of medical service use in US cancer patients and similar non-cancer patients aged 65 years and older based on Medicare claims data were combined with service-specific time estimates from national surveys and an hourly value of time. Contribution Patient time costs vary widely by cancer type and phase of care. From the estimated number of patients diagnosed with cancer in 2005 in the US, the estimated patient time cost during the first year of treatment for all 11 types of cancer examined was $2.3 billion. Implications Costs of time associated with medical care for cancer patients are substantial. Differences observed among cancer type and phase of care are likely due to differences in stage at diagnosis and availability and intensity of treatment. Limitations The authors used data from Medicare claims and national surveys to calculate time estimates rather than direct measurement for most services. Although Medicare claims accurately record types of treatment received and duration of hospitalization, they do not provide hourly estimates of treatment duration or travel and waiting time. Survey data based on national averages may underestimate time spent by cancer patients travelling, waiting, and receiving care.
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Editorial about this Article
- The Forest and the Trees: the Human Costs of Cancer
- Larry G. Kessler and Scott D. Ramsey
J Natl Cancer Inst 2007 99: 2-3.[Extract] [Full Text] [PDF]
Related Article in JNCI
- Press Release: Study Calculates Patient Time Costs Associated with Cancer Care
- Andrea Widener
J Natl Cancer Inst 2007 99: 1.[Extract] [Full Text]
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