Due to scientific advances in oncology, increased use of more expensive cancer treatments, and an aging population, the cost of cancer care is expected to increase enormously. In 2010, the national cost of cancer care was estimated to be $124.6 billion USD in the SEER-Medicare population, of which female breast cancer (BC) constituted the highest proportion at 13% ($16.5 billion). Further, it is projected to increase by 32% in 2020, presenting a significant burden to Medicare.1 Of the $16.5 billion, the initial phase of care (12 months) following BC diagnosis represented 37% of the cost, the continuing phase of care 41%, and the last year of life accounted for 22%. BC costs are substantially higher for the initial phase of care due to surgery, radiotherapy (RT), and adjuvant therapy.2–6 Regardless of these extensive costs to Medicare, there is insufficient up-to-date information on healthcare utilization and costs incurred by specific services, and factors significantly contributing to these costs in women aged ≥65 years. Because older women have higher BC incidence than their younger counterparts,7 it is important to determine the economic burden of BC in planning for future healthcare resource allocation.
A descriptive review about the costs of cancer care in the United States reported that studies varied widely regarding settings, methodologies, cost perspectives, populations, measurements of costs, types of services included, time horizons, and data sources.8 Another systematic review included outdated studies, which may not reflect changes in the patterns of care due to technological advances and innovations in BC treatment.3 Furthermore, other studies used data from fewer cancer registries, and not for all BC stages.1,2,6,9,10 Additionally, costs according to types of specific services have not been reported.6,10 One study that determined costs during the initial phase of care for Medicare beneficiaries with BC in Virginia reported comorbidity, hospital stay, and type of treatment as the significant cost contributors.11 Another study that used SEER-Medicare data reported higher healthcare utilization, although the study findings had limited generalizability due to inclusion of only 4 SEER geographic areas.9 In fact, to date, no single comprehensive study focusing on both healthcare utilization and costs during the initial phase of care in older women with BC from all SEER areas has been published with the results stratified by specific services.
The purpose of this study was to determine the treatment approaches and healthcare utilization and costs during the initial phase of BC care among female Medicare fee-for-service beneficiaries using the SEER-Medicare data, and to determine factors associated with costs using a multivariate framework.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
This study was part of Dr. Vyas' doctoral dissertation at West Virginia University and was supported by an AHRQ grant (R24HS018622-03). Some additional salary support was received by Drs. Madhavan and Sambamoorthi from a National Institute of General Medicine Sciences (NIGMS) IDeA Clinical and Translational Research grant (U54GM104942) obtained by West Virginia University. The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ and NIGMS.
Partial results of this analyses were presented at the International Society for Pharmacoeconomics and Outcomes Research 20th Annual International Meeting; Philadelphia, PA; May 16–20, 2015.
BrownMLRileyGFSchusslerNEtzioniR. Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care2002;40(8 Suppl):IV-104–117.
CampbellJDRamseySD. The costs of treating breast cancer in the US: a synthesis of published evidence. Pharmacoeconomics2009;27:199–209.
RileyGFPotoskyALLubitzJDKesslerLG. Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Med Care1995;33:828–841.
WarrenJLBrownMLFayMP. Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings. J Clin Oncol2002;20:307–316.
HowladerNNooneAMKrapchoM eds. SEER Cancer Statistics Review 1975-2013National Cancer Institute. Bethesda, MD based on November 2011 SEER data submission April2012. Available at: http://seer.cancer.gov/csr/1975_2013/. Accessed January 21 2017.
HanchateADClough-GorrKMAshAS. Longitudinal patterns in survival, comorbidity, healthcare utilization and quality of care among older women following breast cancer diagnosis. J Gen Intern Med2010;25:1045–1050.
PenberthyLRetchinSMMcDonaldMK. Predictors of Medicare costs in elderly beneficiaries with breast, colorectal, lung, or prostate cancer. Health Care Manag Sci1999;2:149–160.
WarrenJLKlabundeCNSchragD. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care2002;40(8 Suppl):IV-3–18.
EngelsEAPfeifferRMRickerW. Use of Surveillance, Epidemiology, and End Results-Medicare data to conduct case-control studies of cancer among the US elderly. Am J Epidemiol2011;174:860–870.
National Cancer Institute Division of Cancer Control & Population Sciences. SEER-Medicare: About the Data Files. Available at: http://healthcaredelivery.cancer.gov/seermedicare/aboutdata/. Accessed January 21 2017.
U.S. Health Resources and Services Administration. Bureau of Health Professions. Area Resource File 2009–2010 Release. Rockville, MD: US Department of Health and Human Services; Fairfax, VA: Quality Resource Systems, Inc; 2010. Codebook: HE-001(2010).
TaplinSHBarlowWUrbanN. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst1995;87:417–426.
United States Department of LaborBureau of Labor Statistics. Consumer price index medical care services 1982-84. Available at: https://www.bls.gov/cpi/. Accessed January 21 2017.
AndersenRNewmanJF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc1973;51:95–124.
KlabundeCNPotoskyALLeglerJMWarrenJL. Development of a comorbidity index using physician claims data. J Clin Epidemiol2000;53:1258–1267.
National Cancer Institute Division of Cancer Control & Population Sciences. SEER-Medicare: Calculation of Comorbidity Weights. Available at: https://healthcaredelivery.cancer.gov/seermedicare/considerations/calculation.html. Accessed January 21 2017.
YuXMcBeanAMVirnigBA. Physician visits, patient comorbidities, and mammography use among elderly colorectal cancer survivors. J Cancer Surviv2007;1:275–282.
FDA Approved Drugs for Oncology: Drugs Approved in 2017. Available at: https://www.centerwatch.com/drug-information/fda-approved-drugs/therapeutic-area/12/oncology. Accessed April 28 2017.
HowardDHChernewMEAbdelgawadT. New anticancer drugs associated with large increases in costs and life expectancy. Health Affairs2016;35:1581–1587.
RobertsKBSoulosPRHerrinJ. The adoption of new adjuvant radiation therapy modalities among Medicare beneficiaries with breast cancer: clinical correlates and cost implications. Int J Radiat Oncol Biol Phy2013;85:1186–1192.
YangRLNewmanASLinIC. Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation. Cancer2013;119:2462–2468.
KennedyTStewartAKBilimoriaKY. Treatment trends and factors associated with survival in T1aN0 and T1bN0 breast cancer patients. Ann Surg Oncol2007;14:2918–2927.
ShihYCEltingLSHalpernMT. Factors associated with immunotherapy use among newly diagnosed cancer patients. Med Care2009;47:948–958.
HalpernMTYabroffKR. Prevalence of outpatient cancer treatment in the United States: estimates from the Medical Expenditures Panel Survey (MEPS). Cancer Invest2008;26:647–651.
SillimanRATroyanSLGuadagnoliE. The impact of age, marital status, and physician-patient interactions on the care of older women with breast carcinoma. Cancer1997;80:1326–1334.
EscarceJJEpsteinKRColbyDC. Racial differences in the elderly's use of medical procedures and diagnostic tests. Am J Public Health1993;83:948–954.
GornickMEEggersPWReillyTW. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med1996;335:791–799.
SubramanianSTangkaFKSabatinoSA. Impact of chronic conditions on the cost of cancer care for Medicaid beneficiaries. Medicare Medicaid Res Rev2013;2:pii: mmrr.002.04.a07.