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Published in: Breast Cancer Research and Treatment 2/2008

01-05-2008 | Epidemiology

Assessing the economic burden of breast cancer in a US managed care population

Authors: John J. Barron, Ralph Quimbo, Prashant T. Nikam, Mayur M. Amonkar

Published in: Breast Cancer Research and Treatment | Issue 2/2008

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Abstract

Background

Breast cancer is the most commonly diagnosed non-skin cancer and second leading cause of cancer deaths among women in the US. This study compared healthcare resource utilization and costs in women with breast cancer to a control group in a managed care population.

Material and methods

Women ≥ 18 years with breast cancer were identified using ICD-9 codes from claims databases of five US health plans during 2004. A randomly matched control group of women without cancer served as a comparator group. Healthcare costs included all medical and pharmacy costs during the year. Comparisons were made using per patient per month (PPPM) costs (total costs per patient within 2004 calendar year/months of eligibility).

Results

10,697 women (mean age 55 years) with breast cancer were identified (prevalence of 250 per 100,000) in 2004, with prevalence increasing with age. Mean attributable PPPM costs associated with breast cancer were $2,896 (median = $1,940) with hospitalization contributing most of the costs ($1,340), followed by pharmacotherapy ($537), and surgical intervention ($470). Mean unadjusted all-cause PPPM total costs were $4,421 (median = $2,964) compared to $3,352 (median = $665) p < 0.0001) for cases and controls respectively. Multivariate analyses controlling for differences in comorbidities showed mean adjusted PPPM costs to be 2.28 times (p < 0.0001) higher than non-breast cancer controls.

Discussion

This study demonstrated that breast cancer treatment was associated with substantial healthcare costs, driven mainly by hospitalizations. Projected annual costs for a breast cancer patient would be at least $12,828 higher than that for women without breast cancer based upon unadjusted cost differences.
Literature
1.
go back to reference Brown ML, Lipscomb J, Snyder C (2001) The burden of illness of cancer: economic cost and quality of life. Annu Rev Public Health 22:91–113PubMedCrossRef Brown ML, Lipscomb J, Snyder C (2001) The burden of illness of cancer: economic cost and quality of life. Annu Rev Public Health 22:91–113PubMedCrossRef
2.
go back to reference Osteen R. Breast Cancer (2001) In: Lenhard R, Osteen R, Gansler T (eds) Clinical oncology. American Cancer Society Osteen R. Breast Cancer (2001) In: Lenhard R, Osteen R, Gansler T (eds) Clinical oncology. American Cancer Society
4.
5.
go back to reference Ries L, Eisner M, Kosary C et al (2005) SEER Cancer Statistics Review, 1975–2002. http://seer.cancer.gov/csr/1975_2002/ National Cancer Institute Ries L, Eisner M, Kosary C et al (2005) SEER Cancer Statistics Review, 1975–2002. http://​seer.​cancer.​gov/​csr/​1975_​2002/​ National Cancer Institute
6.
go back to reference Smigal C, Jemal A, Ward E et al (2006) Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 56:168–183PubMed Smigal C, Jemal A, Ward E et al (2006) Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 56:168–183PubMed
7.
go back to reference Elkin EB, Hudis C, Begg CB et al (2005) The effect of changes in tumor size on breast carcinoma survival in the US: 1975–1999. Cancer 104:1149–1157PubMedCrossRef Elkin EB, Hudis C, Begg CB et al (2005) The effect of changes in tumor size on breast carcinoma survival in the US: 1975–1999. Cancer 104:1149–1157PubMedCrossRef
8.
go back to reference National Comprehensive Cancer Network (2006) NCCN Practical Guidelines in Oncology: Breast Cancer, v.2.2006 National Comprehensive Cancer Network (2006) NCCN Practical Guidelines in Oncology: Breast Cancer, v.2.2006
9.
go back to reference Bloom BS, de Pouvourville N, Chhatre S et al (2004) Breast cancer treatment in clinical practice compared to best evidence and practice guidelines. Br J Cancer 90:26–30PubMedCrossRef Bloom BS, de Pouvourville N, Chhatre S et al (2004) Breast cancer treatment in clinical practice compared to best evidence and practice guidelines. Br J Cancer 90:26–30PubMedCrossRef
10.
go back to reference Lazovich DA, White E, Thomas DB et al (1991) Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA 266:3433–3438PubMedCrossRef Lazovich DA, White E, Thomas DB et al (1991) Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA 266:3433–3438PubMedCrossRef
11.
go back to reference Malin JL, Schuster MA, Kahn KA et al (2002) Quality of breast cancer care: what do we know? J Clin Oncol 20:4381–4393PubMedCrossRef Malin JL, Schuster MA, Kahn KA et al (2002) Quality of breast cancer care: what do we know? J Clin Oncol 20:4381–4393PubMedCrossRef
12.
go back to reference Fireman BH, Quesenberry CP, Somkin CP et al (1997) Cost of care for cancer in a health maintenance organization. Health Care Financ Rev 18:51–76PubMed Fireman BH, Quesenberry CP, Somkin CP et al (1997) Cost of care for cancer in a health maintenance organization. Health Care Financ Rev 18:51–76PubMed
13.
go back to reference Legorreta AP, Brooks RJ, Leibowitz AN et al (1996) Cost of breast cancer treatment. A 4-year longitudinal study. Arch Intern Med 156:2197–2201 Legorreta AP, Brooks RJ, Leibowitz AN et al (1996) Cost of breast cancer treatment. A 4-year longitudinal study. Arch Intern Med 156:2197–2201
14.
go back to reference Taplin SH, Barlow W, Urban N et al (1995) Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 87:417–426PubMedCrossRef Taplin SH, Barlow W, Urban N et al (1995) Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 87:417–426PubMedCrossRef
15.
go back to reference Rao S, Kubisiak J, Gilden D (2004) Cost of illness associated with metastatic breast cancer. Breast Cancer Res Treat 83:25–32PubMedCrossRef Rao S, Kubisiak J, Gilden D (2004) Cost of illness associated with metastatic breast cancer. Breast Cancer Res Treat 83:25–32PubMedCrossRef
16.
go back to reference American Cancer Society (2005) Breast Cancer Facts & Figures 2005–2006. http://www.cancer.org/downloads/STT/CAFF2005BrFacspdf2005.pdf American Cancer Society (2005) Breast Cancer Facts & Figures 2005–2006. http://​www.​cancer.​org/​downloads/​STT/​CAFF2005BrFacspd​f2005.​pdf
17.
go back to reference Kutikova L, Bowman L, Chang S et al (2005) The economic burden of lung cancer and the associated costs of treatment failure in the United States. Lung Cancer 50:143–154PubMedCrossRef Kutikova L, Bowman L, Chang S et al (2005) The economic burden of lung cancer and the associated costs of treatment failure in the United States. Lung Cancer 50:143–154PubMedCrossRef
18.
go back to reference Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef
19.
go back to reference Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619PubMedCrossRef Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619PubMedCrossRef
20.
go back to reference Nuttall M, van der MJ, Emberton M (2006) Charlson scores based on ICD-10 administrative data were valid in assessing comorbidity in patients undergoing urological cancer surgery. J Clin Epidemiol 59:265–273 Nuttall M, van der MJ, Emberton M (2006) Charlson scores based on ICD-10 administrative data were valid in assessing comorbidity in patients undergoing urological cancer surgery. J Clin Epidemiol 59:265–273
21.
go back to reference Farley JF, Harley CR, Devine JW (2006) A comparison of comorbidity measurements to predict healthcare expenditures. Am J Manag Care 12:110–119PubMed Farley JF, Harley CR, Devine JW (2006) A comparison of comorbidity measurements to predict healthcare expenditures. Am J Manag Care 12:110–119PubMed
22.
go back to reference Bernardini J, Callen S, Fried L et al (2004) Inter-rater reliability and annual rescoring of the Charlson comorbidity index. Adv Perit Dial 20:125–127PubMed Bernardini J, Callen S, Fried L et al (2004) Inter-rater reliability and annual rescoring of the Charlson comorbidity index. Adv Perit Dial 20:125–127PubMed
23.
go back to reference O’Connor GT, Plume SK, Olmstead EM et al (1991) A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group. JAMA 266:803–809 O’Connor GT, Plume SK, Olmstead EM et al (1991) A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group. JAMA 266:803–809
24.
go back to reference Roos LL, Sharp SM, Cohen MM et al (1989) Risk adjustment in claims-based research: the search for efficient approaches. J Clin Epidemiol 42:1193–1206PubMedCrossRef Roos LL, Sharp SM, Cohen MM et al (1989) Risk adjustment in claims-based research: the search for efficient approaches. J Clin Epidemiol 42:1193–1206PubMedCrossRef
25.
go back to reference Roos LL, Sharp SM, Cohen MM (1991) Comparing clinical information with claims data: some similarities and differences. J Clin Epidemiol 44:881–888PubMedCrossRef Roos LL, Sharp SM, Cohen MM (1991) Comparing clinical information with claims data: some similarities and differences. J Clin Epidemiol 44:881–888PubMedCrossRef
26.
go back to reference SEER 2003. SEER Surveillance Epidemiology and End Results. http://seer.cancer.gov/statfacts/html/breast.html. National Cancer Institute SEER 2003. SEER Surveillance Epidemiology and End Results. http://​seer.​cancer.​gov/​statfacts/​html/​breast.​html.​ National Cancer Institute
27.
go back to reference Ballard-Barbash R, Potosky AL, Harlan LC et al (1996) Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst 88:716–726PubMedCrossRef Ballard-Barbash R, Potosky AL, Harlan LC et al (1996) Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst 88:716–726PubMedCrossRef
28.
go back to reference Janjan N, Nattinger A, Young M et al (1993) First-year treatment charges for early-stage vs locally advanced breast cancer. Breast Dis 6:23–27 Janjan N, Nattinger A, Young M et al (1993) First-year treatment charges for early-stage vs locally advanced breast cancer. Breast Dis 6:23–27
29.
go back to reference Baker MS, Kessler LG, Urban N et al (1991) Estimating the treatment costs of breast and lung cancer. Med Care 29:40–49PubMedCrossRef Baker MS, Kessler LG, Urban N et al (1991) Estimating the treatment costs of breast and lung cancer. Med Care 29:40–49PubMedCrossRef
30.
go back to reference Warren J, Brown M, Fay M et al (2002) Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings. J Clin Oncol 20:307–331PubMedCrossRef Warren J, Brown M, Fay M et al (2002) Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings. J Clin Oncol 20:307–331PubMedCrossRef
31.
go back to reference Riley GF, Potosky AL, Lubitz JD et al (1995) Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Med Care 33:828–841PubMedCrossRef Riley GF, Potosky AL, Lubitz JD et al (1995) Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Med Care 33:828–841PubMedCrossRef
32.
go back to reference Hewitt M, Simone J (1999) Ensuring quality cancer care. National Academy Press Hewitt M, Simone J (1999) Ensuring quality cancer care. National Academy Press
33.
go back to reference Silliman RA, Troyan SL, Guadagnoli E et al (1997) The impact of age, marital status, and physician-patient interactions on the care of older women with breast carcinoma. Cancer 80:1326–1334PubMedCrossRef Silliman RA, Troyan SL, Guadagnoli E et al (1997) The impact of age, marital status, and physician-patient interactions on the care of older women with breast carcinoma. Cancer 80:1326–1334PubMedCrossRef
34.
go back to reference Brown ML, Riley GF, Schussler N et al (2002) Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care 40:4–17CrossRef Brown ML, Riley GF, Schussler N et al (2002) Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care 40:4–17CrossRef
35.
go back to reference Munoz E, Shamash F, Friedman M et al (1986) Lumpectomy vs mastectomy. The costs of breast preservation for cancer. Arch Surg 121:1297–1301PubMedCrossRef Munoz E, Shamash F, Friedman M et al (1986) Lumpectomy vs mastectomy. The costs of breast preservation for cancer. Arch Surg 121:1297–1301PubMedCrossRef
36.
go back to reference Barlow WE, Taplin SH, Yoshida CK et al (2001) Cost comparison of mastectomy versus breast-conserving therapy for early-stage breast cancer. J Natl Cancer Inst 93:447–455PubMedCrossRef Barlow WE, Taplin SH, Yoshida CK et al (2001) Cost comparison of mastectomy versus breast-conserving therapy for early-stage breast cancer. J Natl Cancer Inst 93:447–455PubMedCrossRef
37.
go back to reference Desch CE, Penberthy LT, Hillner BE et al (1999) A sociodemographic and economic comparison of breast reconstruction, mastectomy, and conservative surgery. Surgery 125:441–447PubMed Desch CE, Penberthy LT, Hillner BE et al (1999) A sociodemographic and economic comparison of breast reconstruction, mastectomy, and conservative surgery. Surgery 125:441–447PubMed
38.
go back to reference Potosky AL, Merrill RM, Riley GF et al (1997) Breast cancer survival and treatment in health maintenance organization and fee-for-service settings. J Natl Cancer Inst 89:1683–1691PubMedCrossRef Potosky AL, Merrill RM, Riley GF et al (1997) Breast cancer survival and treatment in health maintenance organization and fee-for-service settings. J Natl Cancer Inst 89:1683–1691PubMedCrossRef
Metadata
Title
Assessing the economic burden of breast cancer in a US managed care population
Authors
John J. Barron
Ralph Quimbo
Prashant T. Nikam
Mayur M. Amonkar
Publication date
01-05-2008
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2008
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-007-9650-4

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