Abstract
Background/Aims Cancer-related costs for Medicare beneficiaries in the indemnity/fee-for-service (FFS) option are well-analyzed, but costs for aged HMO-enrolled cancer patients are less studied. We compared monthly costs for aged breast cancer patients by payment scheme.
Methods Longitudinal case-control design: mean incremental monthly costs starting 12 months prior to diagnosis were estimated using health care utilization data from 4 HMOs and SEER-Medicare. Cases: 7,822 aged Medicare HMO and 74,236 SEER-Medicare FFS female enrollees diagnosed with breast cancer between 01/00–12/08. Controls: 36,232 aged Medicare HMO enrollees with no tumor registry evidence of cancer and 34,754 FFS SEER-Medicare non-cancer beneficiaries for the same time period. HMO controls were frequency matched to cases 5-to-1 by age group and gender. 2008 national Medicare reimbursement rates were applied to monthly use vectors extracted for 2000–2008 and summed to total costs per month per enrollee for each case and control. Costs were analyzed by stage (early [I–III] vs. late [IV]) and four phases of care, each of 12-months duration: pre-diagnosis; treatment; survivorship (first 12 months only); and end-of-life (EOL). Incremental cancer-related costs were computed by subtracting average annual costs for controls from cases from the corresponding payment scheme for the same time period.
Results Pre-Diagnosis: Incremental costs for FFS late-stage (LS) cases started at −$140/mo. one year prior to diagnosis and finished the year at $350/mo. Costs for FFS early-stage (ES) cases increased from −$70/mo. to $110/mo. HMO LS: −$60/mo. to $180/mo. HMO ES: $0/mo. to $120/mo. Treatment: FFS LS: $10,100/mo. to $1,400/mo. FFS ES: $7,200/mo. to $400/mo. HMO LS: $5,000/mo. to $1,600/mo. HMO ES: $4,100/mo. to $600/mo. Survivorship: FFS LS: $1,575/mo. to $940/mo. FFS ES: $270/mo. to $110/mo. HMO LS: $1,050/mo. to $550/mo. HMO ES decreased: $350/mo. to $200/mo. EOL: FFS LS: $1,700/mo. to $2,900/mo. FFS ES: $700/mo. to $1,200/mo. HMO LS: $4,200/mo. to $2,600/mo. HMO ES: $300/mo. to $1,000/mo.
Conclusions FFS controls exceeded HMO controls by >$120/mo. in all phases. FFS treatment costs peaked at time of diagnosis for both staging groups and were much higher than HMO costs. HMO treatment costs peaked at 1 month after diagnosis. FFS treatment costs dropped below HMO costs by end of treatment.
