Benchmark Method for Cost Computations Across Health Care Systems: Cost of Care per Patient per Day in Breast Cancer Care

Abstract

PURPOSE: To estimate the value of cancer care and to compare value among episodes of care, a transparent, reproducible, and standardized cost computation methodology is needed. Charges, claims, and reimbursements are related to cost but are nontransparent and proprietary. We developed a method to measure the cost of the following phases of care: (1) initial treatment with curative intent, (2) surveillance and survivorship care, and (3) relapse and end-of-life care. METHODS: We combined clinical data from our electronic health record, the state cancer registry, and the Social Security Death Index. We analyzed the care of patients with breast cancer and mapped Common Procedural Terminology (CPT) codes to the corresponding cost conversion factor and date in the CMS Medicare fee schedule. To account for varying duration of episodes of care, we computed a cost of care per day (CCPD) for each patient. RESULTS: Median CCPD for initial treatment was $29.45 in US dollars (USD), the CCPD for surveillance and survivorship care was $2.45 USD, and the CCPD for relapse care was $13.80 USD. Among the three breast cancer types (hormone receptor-positive or human epidermal growth factor receptor 2 [HER2]-negative, HER2-positive, and triple-negative), there was no difference in CCPD. Relapsed patients in the most expensive surveillance CCPD group had significantly shorter survival. CONCLUSION: We developed a method to identify high-value oncology care—cost of care per patient per day (CCPD)—in episodes of initial, survivorship, and relapse care. The methodology can help identify positive deviants (who have developed best practices) delivering high-value care. Merging our data with claims data from third-party payers can increase the accuracy and validity of the CCPD.

Computing the Cost of Care per Patient per Day for Patients With Metastatic Neuroendocrine Neoplasms

“…As a result, this methodology is reproducible across various tumor types at the same institution as well as across various institutions. 11 For instance, CCPD for patients with stage 0-III breast cancer during breast cancer relapse at SHC was $13.80 USD 11 compared with CCPD of $119.11 USD for patients with metastatic NENs. The higher CCPD for patients with metastatic NENs in this study is driven by higher systemic treatment costs.…”

“…A limitation of the CCPD methodology is reliance upon the Medicare fee schedule, which may not reflect actual costs or charges or reflect inflationary effects despite being updated yearly. 11 We did not include sunitinib costs in the study because the Medicare fee schedule does not include costs for sunitinib, and there is a lack of reliable historical cost data. However, only six patients in our study received sunitinib.…”

“…We used the CCPD method to measure cost, as it is an evidence-based method that accounts for variation in follow-up duration and variation in tempo of disease progression. 11 This method was also chosen for its ease of replication and generalizability across institutions, as it uses the publicly available Medicare physician fee schedule to normalize cost. Through this method, the total cost of care for each patient was calculated across a monitoring period, defined as the time from metastatic disease diagnosis to one of the following three dates: date of death, most recent date of follow-up, or December 31, 2017, whichever occurred first.…”

“…The cost of care per patient per day (CCPD) is a validated methodology that was developed to estimate the value of cancer care and to compare costs across health care systems, disease types, and physician practices in a transparent, reproducible, and standardized manner. 11 To that end, we aim to calculate the CCPD for patients with metastatic NENs, understand the drivers of these costs, and evaluate whether intense monitoring and higher-cost care add value.…”

Breast Cancer Diagnosis, Treatment, and Outcomes of Patients From Sex and Gender Minority Groups

“…Using the 92 identified patients from SGM groups, we selected matched cisgender heterosexual patients with breast cancer from the Oncoshare database (n = 184). Oncoshare integrates information from the EMRs of 2 San Francisco Bay Area health care systems, Stanford University Health Care and Sutter Medical Network, with patient-level data from the California Cancer Registry, which comprise registries that are also part of the Surveillance, Epidemiology, and End Results Program. Matching variables were age, year of diagnosis, tumor stage, estrogen receptor (ER) status, and ERBB2 (HER2) status.…”