Abstract
Background/Aims The HMO Cancer Research Network received a request from the National Cancer Institute to provide an empirical estimate of the medical care costs of diagnosing lung cancers within a typical HMO setting. This estimate had to be completed within 24 hours. This paper summarizes the methods and data we used to generate our response to this request. We assumed that services delivered during the 90 days prior to the date of the lung cancer diagnosis would provide an acceptable order-of-magnitude estimate of the costs of a diagnosis work-up. We further assumed that additional imaging procedures performed after the date of diagnosis represented treatment costs because their primary purpose was to assist physicians in developing treatment plans.
Methods This analysis was conducted in four large group-model HMOs: Group Health Cooperative, Kaiser Permanente Colorado, Kaiser Permanente Northern California, and Kaiser Permanente Northwest. To be included in the estimates, patients with lung cancer had to be enrolled in one of the four participating health plans for at least 30 days between January 1, 2000 and December 31, 2008. Patients also had to have their lung cancers diagnosed at least 90 days after their effective date of enrollment. Furthermore, patients diagnosed at autopsy were excluded. The following elements of medical care utilization were included: hospitalizations, inpatient days, surgical procedures, doctor office visits, imaging procedures, laboratory tests, and medication dispensings. Outpatient procedures were weighted by Medicare’s Resource-based Relative Value System (RBRVS). We used Medicare’s RBRVS-to-dollars conversion coefficient for 2008 to compute total ambulatory care expenses. Inpatient expenses were computed by a DRG-weighted per diem cost (which preserved variations in lengths of stay). We also identified specific surgical, imaging, and laboratory procedures that were most consistent with a diagnostic work-up for a pulmonary disease in general and lung cancer in particular.
Results We were able to develop and run VDW programs to identify the study population in the four health plans; extract and summarize each utilization element; attach monetary weights to each service; and compute total costs of care for the diagnosis phase.
Conclusions Rapid costing is feasible for the CRN.
