Healthcare cost attributable to recently-diagnosed breast cancer in a privately-insured population in the United States

Figures & data

Table 1.  Characteristics of the study population.

	Cases		Controls		p-value
	n	M or %	n	M or %
Total number of patients	35,057		105,171
Mean age		52.2		52.1	0.0008
Geographic region					1.00
Northeast	3075	8.8%	9225	8.8%
North central	9411	26.8%	28,233	26.8%
South	14,733	42.0%	44,199	42.0%
West	7838	22.4%	23,514	22.4%
Rural (vs urban)	6053	17.3%	19,205	18.3%	<0.0001
Health plan					1.00
Capitation
HMO	6924	19.8%	20,772	19.8%
POS with capitation	530	1.5%	1590	1.5%
Fee-for-service
Comprehensive	3914	11.2%	11,742	11.2%
EPO	107	0.3%	321	0.3%
POS	4199	12.0%	12,597	12.0%
PPO	18,888	53.9%	56,664	53.9%
CDHP	495	1.4%	1485	1.4%
Relation to employee					0.59
Employee	19,843	56.6%	59,253	56.3%
Spouse	15,175	43.3%	45,697	43.5%
Child/other	39	0.1%	221	0.2%
Charlson comorbidity index (at baseline)	35,057	0.333	105,171	0.101	<0.0001
Top 10 comorbid conditions (at baseline)
Hypertension	5867	16.7%	8261	7.9%	<0.0001
Diabetes	2402	6.9%	3583	3.4%	<0.0001
Hypothyroidism	2212	6.3%	3059	2.9%	<0.0001
Chronic pulmonary disease	1546	4.4%	2369	2.3%	<0.0001
Deficiency anemia	1151	3.3%	1304	1.2%	<0.0001
Psychoses	1078	3.1%	1616	1.5%	<0.0001
Other non-metastatic solid tumors	1025	2.9%	584	0.6%	<0.0001
Depression	920	2.6%	1374	1.3%	<0.0001
Rheumatoid arthritis	654	1.9%	1038	1.0%	<0.0001
Other metastatic cancers	554	1.6%	71	0.1%	<0.0001
Baseline (prior 6 months)
Inpatient cost	35,057	$765.57	105,171	$364.53	<0.0001
Outpatient cost	35,057	$3,064.94	105,171	$756.12	<0.0001
Prescription cost	35,057	$838.41	105,171	$509.81	<0.0001
Total healthcare cost	35,057	$4,668.91	105,171	$1630.45	<0.0001
Post-index (12 months)
Inpatient cost	35,057	$7,197.88	105,171	$1499.40	<0.0001
Outpatient cost	35,057	$50,224.54	105,171	$3463.92	<0.0001
Prescription cost	35,057	$3,744.99	105,171	$1333.08	<0.0001
Total health care cost	35,057	$61,167.41	105,171	$6296.40	<0.0001

HMO, health maintenance organization; POS, point of service; EPO, exclusive provider organization; PPO, preferred provider organization; CDEHP, consumer-driven health plan.

Table 2.  Generalized linear model for direct healthcare cost.

	Coefficient	95% Confidence Interval		p-value
Case (vs control)	1.973	1.948	1.998	<0.001
Log of baseline total health care cost	0.073	0.066	0.079	<0.001
Age group (years)
18–24	−0.268	−0.674	0.138	0.20
25–34	0.430	0.376	0.483	<0.001
35–44	0.212	0.186	0.237	<0.001
45–54	0.086	0.067	0.105	<0.001
55–64 (reference)	0
Geographic region
Northeast	−0.069	−0.100	−0.038	<0.001
North central	−0.048	−0.069	−0.027	<0.001
West	−0.147	−0.172	−0.122	<0.001
South (reference)	0
Rural (vs. urban)	0.033	0.010	0.055	0.004
Health plan
HMO	−0.244	−0.269	−0.219	<0.001
POS with capitation	−0.258	−0.336	−0.180	<0.001
Comprehensive	−0.091	−0.120	−0.062	<0.001
EPO	−0.157	−0.288	−0.026	0.019
POS	−0.051	−0.076	−0.026	<0.001
CDHP	0.163	0.092	0.235	<0.001
PPO (reference)	0
Relation to employee
Employee (reference)	0
Spouse	−0.046	−0.063	−0.029	<0.001
Child/other	0.114	−0.205	0.434	0.48
Charlson comorbidity index	0.124	0.044	0.204	0.002

The generalized linear model also contained disease categories from the Agency for Healthcare Research and Quality Comorbidity Software.

HMO, health maintenance organization; POS, point of service; EPO, exclusive provider organization; CDEHP, consumer-driven health plan; PPO, preferred provider organization.

Figure 1.  Direct healthcare costs associated with breast cancer. Bar charts indicate the unadjusted results. Numbers in parentheses are incremental difference after controlling for age, geographic region, rural/urban habitat, type of health plan, relationship to worker, natural logarithm of pre-index total direct cost, Charlson comorbidity index, and comorbidity software disease categories.