Obtaining long-term disease specific costs of care: Application to medicare enrollees diagnosed with colorectal cancer

Martin L. Brown, Gerald F. Riley, Arnold L. Potosky, Ruth D. Etzioni

Research output: Contribution to journalArticle

152 Scopus citations

Abstract

OBJECTIVES. This study develops estimates of long-term, cancer-related treatment cost using a modeling approach and data from the SEER-Medicare linked database. The method is demonstrated for colorectal cancer. METHODS. Data on Medicare payments were obtained for colorectal cancer patients for the years 1990 to 1994 from the SEER-Medicare linked database. Claims payment data for control subjects were obtained for Medicare enrollees without cancer residing in the same areas as patients. Estimates of long-term cost (≤25 years following the date of diagnosis) were obtained by combining treatment/phasespecific cost estimates with estimates of longterm survival from SEER. Treatment phases were defined as initial care, terminal care, and continuing care. Cancer-related estimates for each phase were obtained by subtracting costs for control subjects from the observed costs for cancer patients, matching on age group, gender, and registry area. Estimates of long-term cost ≤11 years obtained by this method were compared with 11-year estimates obtained by application of the Kaplan-Meier sample average (KMSA) method. RESULTS. The mean initial-phase cancerrelated cost was approximately $18,000 but was higher among patients with more advanced cancer. The mean continuing-phase cancerrelated cost was $1,500 per year and declined with increasing age, but was higher on an annual basis among persons with later stages of cancer and shorter survival time. The mean terminal-phase cancer-related cost was $15,000 and declined with both age at death and more advanced stage at diagnosis. After the phasespecific estimates were combined, the average long-term cancer-related cost was $33,700 ($31,300 at 3% discount rate) for colon cancer compared with $36,500 ($33,800 at 3% discount rate) for cancer of the rectum. This represented about half of the total long-term cost for Medicare enrollees diagnosed with this disease. Long-term cost was highest for Stage III cancer and lowest for in situ cancer. Eleven-year cancer-related costs estimated by the KMSA method were similar to estimates using the phase-based approach. CONCLUSIONS. This paper demonstrates that valid estimates of cancer-related long-term cost can be obtained from administrative claims data linked to incidence cancer registry data.

Original languageEnglish (US)
Pages (from-to)1249-1259
Number of pages11
JournalMedical care
Volume37
Issue number12
DOIs
StatePublished - Dec 1 1999
Externally publishedYes

Keywords

  • Cancer
  • Colon
  • Costs
  • Methods
  • Rectum

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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