Cost of cancer management by stage at diagnosis among Medicare beneficiaries

Abstract

Objective

Estimate the annual cost of care in the 5 years following a cancer diagnosis for 17 invasive cancer types, by stage at diagnosis.

Methods

We used 2012–2016 data from the Surveillance, Epidemiology, and End Results (SEER) registry-Medicare claims database to examine cost of care among Medicare beneficiaries with a confirmed cancer diagnosis based on International Classification of Diseases for Oncology, Third Edition histology codes reported in SEER. Beneficiaries contributed to the annual cost calculations (Years 1–5) using their observed time after diagnosis. Beneficiaries were continuously enrolled in fee-for-service Medicare Parts A/B and Part D during follow-up. Total, inpatient, outpatient, and pharmacy cancer-related service costs were calculated.

Results

From 2012 to 2016, we identified 597,778 Medicare beneficiaries with incident cancer diagnosis within 5 years (Stage I, II, III, and IV: 32.6%, 33.4%, 15.9%, and 18.0%, respectively). In Year 1, mean (standard deviation) total costs for Stage I diagnoses varied from $7640 ($17,378) (prostate) to $94,636 ($117,636) (pancreas). Total costs increased by stage and reached $58,783 ($92,344) (prostate) to $156,982 ($175,009) (stomach) for Stage IV diagnoses in Year 1. Costs in Year 1 were significantly higher for Stage IV diagnoses than for earlier stages across all cancer types. In Years 2–5, total costs were lower than in Year 1 but continued to increase by stage.

Conclusions

Beneficiaries diagnosed at later stages of cancer have higher costs of care (up to 7 times as much) than those diagnosed at earlier stages. Earlier cancer diagnosis may lead to more efficient treatment and decreased management cost.

Keywords:

• Cancer
• administrative claims
• SEER
• Medicare
• cost of care
• retrospective
• cross-sectional

Transparency

Declaration of funding

This research was funded by GRAIL, LLC.

Declaration of financial/other relationships

Dr. Reddy is an employee of PHAR, LLC, which was paid by GRAIL, LLC to conduct this research. Dr. Broder is an employee of PHAR, LLC, which was paid by GRAIL, LLC to conduct this research. Dr. Chang is an employee of PHAR, LLC, which was paid by GRAIL, LLC to conduct this research. Mr. Paydar is an employee of PHAR, LLC, which was paid by GRAIL, LLC to conduct this research. Dr. Chung is an employee of GRAIL, LLC with equity in the company. Dr. Kansal is an employee of GRAIL, LLC with equity in the company. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors fulfilled the ICMJE authorship requirements.

Data availability statement

Data are available from National Cancer Institute, Healthcare Delivery Research Program.

Previous presentations

Figures and tables in this manuscript have been included in posters presented at the 2021 Hematology/Oncology Pharmacy Association (HOPA) virtual conference.