Cost drivers for breast, lung, and colorectal cancer care in a commercially insured population over a 6-month episode: an economic analysis from a health plan perspective

Figures & data

Figure 1. Flow diagram of study inclusion and exclusion criteria.

Table 1. Sample demographic and clinical characteristics.

	Breast	Lung	Colon
	(n = 5,700)	(n = 1,621)	(n = 2,427)
Female, n (%)	5,700 (100%)	795 (49%)	1,094 (45%)
Age at time of chemotherapy start in years, mean (±SD)	50.5 (±8.7)	57.0 (±6.3)	52.7 (±8.1)
Median (min, max)	51.0 (21,65)	58.0 (20,65)	54.0 (20,65)
ERG risk score, mean (±SD)	14.47 (±5.9)*	19.81 (±9.3)**	18.04 (±7.0)***
Comorbidity, n (%)
Diabetes	461 (8%)	156 (10%)	283 (17%)
Hypertension	1,208 (21%)	440 (27%)	636 (39%)
Chronic obstructive pulmonary disease	60 (1%)	393 (9%)	49 (3%)
Ischemic heart disease	117 (2%)	153 (9%)	125 (8%)
Congestive heart failure	55 (1%)	35 (2%)	25 (2%)
Cardiomyopathy	55 (1%)	16 (1%)	22 (1%)

* n = 5,692 non-missing;

** n = 1,618 non-missing;

*** n = 2,423 non-missing.

Table 2. Costs by cancer type, facility type, year, and setting.

Item	n	Community cost			n	Facility cost
		Median	Mean	SD		Median	Mean	SD
Breast cancer	4,059	$71,617	$85,691	$59,390	1,641	$91,463	$116,965	$87,332
Metastasis, HER2+	376	$135,567	$152,790	$77,144	181	$178,403	$192,895	$104,633
No metastasis, HER2+	838	$113,293	$122,221	$67,510	278	$147,122	$178,271	$118,646
Metastasis, HER2–	944	$65,264	$73,901	$43,029	520	$87,772	$102,810	$61,959
No metastasis, HER2–	1,901	$56,346	$62,172	$36,470	662	$71,105	$81,580	$49,572
Lung cancer	1,187	$80,849	$97,632	$66,471	434	$120,397	$145,360	$101,859
Metastasis	684	$95,372	$111,396	$66,444	302	$120,481	$165,672	$77,848
Non-metastasis	503	$58,166	$71,227	$46,518	132	$88,994	$98,688	$62,650
Colorectal cancer	1,783	$69,991	$83,824	$59,743	644	$95,360	$119,903	$89,161
Metastasis	754	$88,739	$111,188	$63,819	384	$117,744	$146,713	$72,542
Non-metastasis	1,029	$53,454	$63,773	$44,343	260	$65,682	$80,306	$54,195

Costs reported in 2015 US dollars. All comparisons between provider type were significant via two-groups t-test at p < .001.

HER2+, human epidermal growth factor receptor positive status.

Community total n = 7,029. Facility total n = 2,719.

Table 3. Multivariable regression model maximum likelihood parameter estimates, cost drivers in breast cancer (n = 5,692).

Parameter	Estimate	Standard error	Wald chi-square	p-value
Intercept	11.004	0.051	46,071.8	<.0001*
Metastasis	0.140	0.017	71.8	<.0001*
ERG risk score	0.017	0.001	151.85	<.0001*
Radiation	0.217	0.016	186.11	<.0001*
Age	−0.006	0.001	45.67	<.0001*
HER2+	0.646	0.017	1,423.01	<.0001*
Facility provider	0.283	0.017	273.25	<.0001*

Scaled Pearson Chi-Square = 5,771.29, p = .21.

Eight members had missing Episode Risk Group (ERG) risk score.

* p < .01.

HER2+, human epidermal growth factor receptor positive status.

Table 4. Multivariable regression model maximum likelihood parameter estimates, cost drivers in lung cancer (n = 1,618).

Parameter	Estimate	Standard error	Wald Chi-square	p-value
Intercept	11.083	0.146	5,816	<.0001*
Metastasis	0.389	0.031	157.85	<.0001*
ERG risk score	0.012	0.002	57.54	<.0001*
Radiation	0.148	0.030	24.97	<.0001*
Age	−0.003	0.002	1.93	.164
Female	0.015	0.030	0.26	.607
Facility provider	0.206	0.033	37.55	<.0001*

Scaled Pearson Chi-Square = 1,813.09, p < .05.

Three members had missing Episode Risk Group (ERG) risk score.

* p < .01.

Table 5. Multivariable regression model maximum likelihood parameter estimates, cost drivers in colorectal cancer (n = 2,423).

Parameter	Estimate	Standard error	Wald Chi-square	p-value
Intercept	10.901	0.093	13,825	<.0001*
Metastasis	0.497	0.027	341.77	<.0001*
ERG risk score	0.020	0.002	105.79	<.0001*
Radiation	0.261	0.032	67.22	<.001*
Age	−0.006	0.002	15.8	<.0001*
Female	0.010	0.026	14.67	<.001*
Facility provider	0.215	0.029	53.42	<.0001*

Scaled Pearson Chi-Square = 2,620.61, p < .05.

Four members had missing Episode Risk Group (ERG) risk score.

* p < .01.

Table 6. Distribution of medical costs.

	Breast	Lung	Colorectal	All
Inpatient	6%	13%	15%	10%
Chemotherapy/supportive drugs	53%	40%	42%	48%
Radiation	10%	16%	8%	11%
Imaging^a	2%	5%	3%	3%
Outpatient surgery	7%	2%	4%	5%
Other^b	22%	24%	29%	24%

^a Imaging includes computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET).

^b Other includes emergency room, lab, diagnostic tests, pathology, office visits, and other ancillary costs.

Table

0073T	0182T	0197T	330	333	339	344	973	32553	32701
330	333	339	344	49411	55875	55876	55920	61796	61797
61798	61799	61800	76950	76965	77011	77014	77261	77262	77263
77280	77285	77290	77295	77299	77300	77301	77305	77306	77307
77310	77315	77316	77317	77318	77321	77326	77327	77328	77331
77332	77333	77334	77336	77338	77370	77371	77372	77373	77385
77386	77387	77399	77401	77402	77403	77404	77406	77407	77408
77409	77411	77412	77413	77414	77416	77417	77418	77421	77422
77423	77427	77431	77432	77435	77470	77499	77520	77522	77523
77525	77600	77605	77610	77615	77620	77750	77761	77762	77763
77776	77777	77778	77781	77782	77783	77784	77785	77786	77787
77789	77790	77799	973	C1715	C1716	C1717	C1719	C1728	C1879
C2616	C2634	C2635	C2636	C2637	C2638	C2639	C2640	C2641	C2642
C2643	C2698	C2699	C9725	C9726	C9728	G0173	G0251	G0338	G0339
G0340	G6001	G6002	G6004	G6005	G6006	G6008	G6009	G6010	G6012
G6013	G6014	G6015	Q3001	S8030