The Cost of Cancer Care

Studies that focus on long-term costs of cancer care at the individual patient level are more useful as inputs to cost-effectiveness studies or to estimate capitation payments for cancer cases. The articles by Riley et al. and Etzioni et al. use Medicare claims data, linked with tumor registry information, to estimate costs per case according to stage at diagnosis for selected cancers, including breast, colorectal, lung, prostate, bladder, and ovarian (Etzioni). The article by Riley estimates the total Medicare payments for each case, including costs of care for conditions unrelated to cancer. The Etzioni article examines costs attributable to ovarian cancer care.

The articles by Taplin et al. and Fireman et al. assess costs of cancer in two large HMO plans, Group Health Cooperative (GHC) of Puget Sound and Kaiser Permanente, N. California region (KPNC), respectively. Unlike the studies by Riley and Etzioni which only used data only for elderly Medicare patients, the HMO studies include cost data for cancer patients less than age 65. While the Riley and Etzioni studies used Medicare reimbursements as an indirect measure of cost, the HMO-based studies use direct measures of resource use and measures of resource cost from the cost accounting systems of the HMOs, including administrative and overhead costs.

The following publications contain data on the cost of cancer care. To request copies of any of these publications send an e-mail message to Penny Randall-Levy. Please indicate which publication(s) you would like to receive and your name and mailing address.

Updates and extensions of these studies will be posted as they become available.

Brown ML, Riley GF, Schussler N, Etzioni RD. Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care 2002 Aug;40(8 Suppl):IV-104-17.

This paper describes the cost-related data available in the SEER-Medicare database, and discusses techniques and methods that have been used to derive various cost estimates from these data. The limitations of SEER-Medicare data as a source of cost estimates are also discussed. Examples of cost estimates for colorectal and breast cancer derived from SEER-Medicare are presented, including estimates of incidence-based cost (average cost per patient) by the initial, terminal, and continuing care phases of cancer treatment. Estimates of cancer-related treatment costs for the Medicare program and for US cancer patients are presented for the thirteen most common types of cancer.

Barlow WE, Taplin SH, Yoshida CK, Buist DS, Seger D, Brown ML. A cost comparison of mastectomy versus breast conserving therapy for early-stage breast cancer. J Natl Cancer Inst 2001;93:447-55.

Compares the costs of all medical care for women with early-stage breast cancer cases treated by breast-conserving therapy (BCT) or mastectomy in the setting of a large non-profit Health Maintenance Organization. Computes the costs of all medical care for the period 1990 through 1998 for each woman and analyzes monthly costs by treatment, adjusting for age and cancer stage.

Warren JL, Brown ML, Fay MP, Schussler N, Potosky AL, Riley GF. Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings. J Clin Oncol 2001;20:307-316.

Provides population-based estimates of the treatment costs for elderly women with early-stage breast cancer, with emphasis on costs of modified radical mastectomy (MRM) compared with breast-conserving surgery. [See Research Summary]

Brown ML, Riley GF, Potosky AL, Etzioni RD. Obtaining long-term disease specific costs of care: Application to Medicare enrollees diagnosed with colorectal cancer. Med Care 1999;37:1249-1259.

Describes a case-control method for estimating cancer-related treatment costs, provides estimates of long-term treatment costs for colon and rectal cancer by stage, and also provides estimates of treatment cost by initial care, continuing care and terminal care treatment phases.

Fireman B, Quesenberry C, Somkin C, Jacobson A, Baer D, Brown, ML, Potosky AL, West D. The cost of care for cancer in a health maintenance organization. Health Care Finance Review 1997;18:51-76.

Provides estimates, in 1992 dollars, of Kaiser Permanente of Northern California costs per case, mean hospital days per case, mean outpatient visits per case, and mean impatient costs per case, by cancer site (breast, colon, rectum, lung, ovarian, prostate, non-Hodgkin’s lymphoma) and stage-at-diagnosis, for initial, continuing and terminal care. Also provides resource use and cost per year, long-term (15 year) costs, and long-term costs attributable to cancer care.

Etzioni R, Urban N, Baker M. Estimating the costs attributable to a disease with application to ovarian cancer. J Clin Epidemiol 1996;49:95-103.

Reviews methods for estimating longitudinal costs from observational data. Provides estimates, by stage at diagnosis, in 1990 dollars, of long-term (15 year) Medicare expenditures per case attributable to the treatment of ovarian cancer.

Riley GF, Potosky AL, Lubitz JD, Kessler LG. Medicare payments from diagnosis to death for aged cancer patients by stage at diagnosis. Med Care 1995;33:828-841.

Provides estimates, in 1990 dollars, of Medicare expenditures per case, by cancer site (lung, breast, prostate, colon/rectum, bladder) and stage-of-diagnosis, for initial, continuing, pre-final and final care.

Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 1995;87:417-426.

Provides estimates, in 1992 dollars, of Group Health Cooperative of Puget Sound costs per case, by cancer site (colon, prostate and breast) and stage-at-diagnosis, for initial, continuing and terminal care. Also gives cost estimates by age and comorbidity categories.