Health Care Expenditure Burden of Cancer Care in the United States

Abstract

Using nationwide data, this study estimated and compared annual health care expenditures per person between noncancer and cancer patients, and among patients with the 4 most common cancers. Two-part models were used to estimate mean expenditures for each group by source of payment and by service type. We found that cancer patients had nearly 4 times higher mean expenditures per person ($16 346) than those without cancer ($4484). These differences were larger among individuals aged 18 to 64 years than those ≥65 years. Medicare was the largest source of payment for cancer patients, especially among those ≥65 years. Among the 4 most common cancers, the most costly cancer was lung cancer. Ambulatory care visits accounted for the majority of health care expenditures for those with breast cancer, while for those with other cancers, inpatient services also contributed to a significant portion of expenditures especially among younger patients. This study demonstrates that cancer patients experience a substantially higher health care expenditure burden than noncancer patients, with lung cancer patients having the highest expenditures. Expenditure estimates varied by age group, source of payment, and service type, highlighting the need for comprehensive policies and programs to reduce the costs of cancer care.

“All about the money?” A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

“…Furthermore, the rising costs of cancer treatment, although a challenge in many countries, have been described as particularly problematic in the USA [ 28 , 29 ]. The combination of a comparatively high proportion of people without health coverage [ 30 ] and rising out-of-pocket costs paid by insured patients with cancer [ 31 ] lead to substantial financial toxicity in patients with cancer [ 32 ]. This burden can be aggravated by the opacity of treatment costs, which was described in our study and which is uniquely relevant in the US health care system [ 33 ].…”

Can Oncotype DX testing be omitted in invasive breast cancer patients with clinicopathologic factors predicting very high pretest probability of a concordant result?

“…Narrowing the indication for routine ODX testing to those in the intermediate pretest probability group is of particular interest in our predominantly Medicaid-based safety-net health system, where omitting low-value ODX testing in patients with a high probability of concordant result can allow for shifting resources to provide other high-value cancer care. 12,13 Limitations of our study include the retrospective study design from a single institution with small cohort size. Also, this cohort is comprised predominantly of an ethnic minority patient population which may impact generalizability of results.…”

“…In our cohort, ODX testing was the least valuable among the 30% of patients who had “very low” or “very high” pretest probability of a high ODX score based on readily available CP factors derived from standard pathology reports. Narrowing the indication for routine ODX testing to those in the intermediate pretest probability group is of particular interest in our predominantly Medicaid‐based safety‐net health system, where omitting low‐value ODX testing in patients with a high probability of concordant result can allow for shifting resources to provide other high‐value cancer care 12,13 …”

“…9 ODX recurrence scores for each patient were collected, and TAILORx-based chemotherapy recommendations were determined for each. 3,4,6 Among patients over age 50 with ODX scores of [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Univariate and multivariable analyses of CP factors for predicting ODX score groups and correlating TAILORx-based treatment recommendations were performed. Missing grade (0.5%, n = 1) and proliferative indices (20.9%, n = 45) were excluded from respective analyses.…”

Reducing time to treatment and patient costs with breast cancer: the impact of patient visits

“…Beyond the impact on TTI, there are both direct and indirect costs associated with multiple visits that affect patients. The costs of breast cancer treatments continue to rise, with a resulting increase in economic burden for patients and payers, which has been well described in the literature 3‐6 . However, there are limited data on the impact of the number of visits on TTI as well as patients’ costs associated with diagnosis and initiation of treatment, which can include lost wages, childcare costs, as well as costs for transportation, parking, and food during visits for treatment planning.…”