Cancer Cost Planning and Accounting for Patients Under 65
A new study published by Banegas et al in JNCCN–Journal of the National Comprehensive Cancer Network has found that cancer care costs in the United States are higher for people under age 65—and that costs increase with disease stage.
Despite the fact that nearly half of new cancer diagnoses occur in people younger than 65, most cost projections are based on SEER-Medicare data, which is typically limited to populations aged 65 or older. This new research compares medical care cost estimates for individuals age 18 and above, providing important evidence about the cost of cancer care across the age spectrum.
“We felt it was important to improve our understanding of cancer costs in the United States for adults of all ages,” said lead author Matthew P. Banegas, PhD, a health services researcher with the Kaiser Permanente Center for Health Research in Portland, Oregon. “Our hope is that the cost estimates in our study will be a valuable resource not only for future research—including inputs for cost- and comparative-effectiveness analyses—but also for oncology program and policy planning within health systems. Any effort to bend the cancer care cost curve must be informed by reliable data from multiple health settings and populations. Our study represents an important step in that direction, and we hope that future studies will continue to help us understand overall costs and cost drivers.”
Study Methods
The researchers looked at 45,522 adults diagnosed with cancer between January 1, 1988, and December 31, 2007, with at least 30 days of continuous health plan eligibility during the study period (January 1, 2000, through December 31, 2008). All were enrolled in one of the following four health plans: Henry Ford Health System (Detroit); Kaiser Permanente Colorado (Denver); Kaiser Permanente Northwest (Portland, Oregon); and Kaiser Permanente Washington (formerly Group Health Cooperative, Seattle). These plans provide both private and public health insurance coverage, including Medicare Advantage and Medicaid risk contracts. Patients were matched with a control population without any history of cancer. Medical care costs were estimated using the Standardized Relative Resource Cost Algorithm. The participants were followed until date of death, disenrollment from their health plan, or the end of the observation.
Findings
The study examined medical care costs for the four most common types of cancer in the United States: breast, colorectal, lung, and prostate cancer. The researchers found average 1-year costs for lung cancer ranged from $50,700 (stage I) to $97,400 (stage IV) among patients younger than 65, and from $44,000 (stage I) to $71,200 (stage IV) among patients aged 65 and older (reported in 2015 dollars and adjusted for inflation). Five-year costs followed the same pattern. In general, it was more expensive to treat lung and breast cancers than colorectal or prostate cancers, but care got more expensive in later stages for all types.
Dr. Banegas offered a word of caution that these numbers could be on the low side: “Given that cancer care costs have continued to rise since the end of our study period (2008), the costs we report serve as conservative estimates of what we expect to see for the foreseeable future.”
In addition to expanding on the age group, the researchers extended findings from similar studies based on Medical Expenditure Panel Survey (MEPS) data, adding key clinical information such as stage at diagnosis and date of diagnosis. Their hope is to provide a unique tool for comparing monthly phase-of-care, 1-year, and 5-year cost estimates based on age at diagnosis, stage at diagnosis, and total vs net cost.
The findings confirm prior research demonstrating that screening and early detection is cost effective compared with treating cancer after it becomes symptomatic.
“This study emphasizes some important lessons about cancer care and prevention,” said Dawn Provenzale, MD, MS, Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Colorectal Cancer Screening. “Namely, treatment for early stage cancer is less costly than treatment for later stage disease, underscoring the importance of screening in order to detect cancer at an earlier stage. Identifying and treating cancer at an early stage can save money and lives in the long term. The authors should be congratulated for providing new information on cancer care costs that emphasizes the importance of prevention and early detection.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
