Abstract
Background/Aims The majority of data on the medical costs of caring for cancer is based on aged Medicare beneficiaries treated in the indemnity/fee-for-service (FFS) system. Much fewer data are available on the costs of treating cancer in patients less than 65 years old. Using data from 4 CRN sites, we examined the cost of treating cancer by phase of care and stage of cancer for aged (65+) versus adult non-aged (greater than 18 and less than 65 years) HMO patients.
Methods We used a longitudinal case-control design to estimate cancer care costs for patients starting 12 months prior to diagnosis. Aged (N = 46,032) and non-aged (N = 46,423) HMO cancer patients were enrolled between 01/2000 and 12/2008. We sampled 171,448 aged and 203,312 non-aged controls from among all HMO members who had no tumor registry evidence of cancer prior to 2009. HMO controls were frequency matched to cancer cases on a 5-to-1 ratio by age group and gender. Health care utilization data were extracted for 2000–2008. Cost coefficients derived from modified national Medicare reimbursement systems were applied to utilization data and summed to total monthly costs per patient in 2008 dollars. Monthly costs were analyzed by four 12-month periods—Pre-diagnosis, Treatment, Survivorship, and End-of-life (EOL)—by case/control, aged/non-aged and stage I–III/IV. Only one year of Survivorship was included in this analysis.
Results Average monthly cost differences between aged and non-aged were reported. Pre-Diagnosis: Aged > Non-aged (difference of $261, P <0.0001); both groups see sharp increases in quarter prior to diagnosis. Treatment: Non-aged > Aged costs ($201, P <0.0001). Survivorship: Aged > Non-aged ($44, P <0.0375). EOL: Non-aged > Aged costs ($2,173, P <0.0001). All groups experienced accelerating EOL costs. Late-stage cancer costs were greater than costs of early-stage and, except for the Pre-diagnosis phase, non-aged late-stage costs were higher than aged late-stage. Late-stage cancer costs were more variable in the Survivorship phase. Aged and non-aged cases were significantly more expensive than their controls in all phases.
Conclusions Non-aged cases are more costly than aged cases during Treatment and EOL phases; however, pattern changes and age effects dominate during the Pre-diagnosis and Survivorship phases.
