Healthcare Utilization and Costs During the Initial Phase of Care Among Elderly Women With Breast Cancer

Abstract

Background Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service beneficiaries diagnosed with BC, and to determine the factors associated with higher costs. Methods A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003–2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. Results A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66–69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. Conclusions The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.

Esophageal cancer treatment costs by phase of care and treatment modality, 2000‐2013

“…34 A detailed understanding of recent costs associated with esophageal cancer treatment, based on studies such as ours, is necessary for researchers who hope to predict future cancer care costs. While phase-specific costs have been published for several cancer sites, we found a lack of cost estimates with this level of detail for esophageal cancer in the US 21,35 One phase-specific cost study by Kaye (2018) included esophageal cancer as one of 10 different cancers. 15 The Kaye study estimated a mean annual total cost of $20 433 (mean $1703/month) for the initial phase and $18 760 (mean $1563/month) for the terminal phase.…”

“…While phase‐specific costs have been published for several cancer sites, we found a lack of cost estimates with this level of detail for esophageal cancer in the US One phase‐specific cost study by Kaye (2018) included esophageal cancer as one of 10 different cancers . The Kaye study estimated a mean annual total cost of $20 433 (mean $1703/month) for the initial phase and $18 760 (mean $1563/month) for the terminal phase.…”

Economic burden of cancers in Taiwan: a direct and indirect cost estimate for 2007–2017

“…Open access of costs is largely limited to direct medical costs from a payer's perspective [7][8][9][10] without taking into account indirect costs such as morbidity (ie, productivity loss) and mortality (ie, premature death) costs attributable to cancer from a societal perspective. This approach may underestimate the economic burden of cancers and may make justification of the value of innovative oncology treatment difficult.…”

Imaging at diagnosis impacts cancer‐specific survival among patients with cancer of the oropharynx

“…A prior city‐based imaging use analysis found the highest rates of PET use in the South (Atlanta, Georgia) and the lowest in the West (Seattle, Washington) . However, it does fit the increased rates of use demonstrated in the Western region on multiple prior SEER‐based studies . This difference in use did not result in significant differences in OS or CSS between the regions, although the West did have the highest CSS of the 4 regions.…”

“…31 However, it does fit the increased rates of use demonstrated in the Western region on multiple prior SEER-based studies. [32][33][34] This difference in use did not result in significant differences in OS or CSS between the regions, although the West did have the highest CSS of the 4 regions. Although these differences may be due Cancer August 15, 2019 to practice patterns, training experiences, or patient preference, further study is warranted to explore the potential causes as to why such significant differences exist with regard to rates of imaging use.…”