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measurements of costs, types of services included, time horizons, and data sources.8 Another systematic review included outdated studies, which may not reflect changes in the patterns of care due to technological advances and innovations in BC treatment.3 Furthermore, other studies used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.
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