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COMPLETED RESEARCH: CLINICAL/TRANSLATIONAL RESEARCH
Abstract #CT05

Cost of Cancer Management by Stage of Diagnosis Among Medicare Beneficiaries

JHOP - March 2021 Vol 11 Special Feature - HOPA Abstracts, Cost of Care

Presenter: Karen C. Chung, PharmD, MS, Senior Director, Health Economics & Outcomes Research, GRAIL

Co-Authors: Eunice Chang, GRAIL; Anuraag R. Kansal, GRAIL; Sheila R. Reddy, GRAIL

Background: A diagnosis of cancer at earlier stages may offer patients less extensive and less costly treatment with decreased morbidity and mortality. The advent of blood-based circulating tumor cell–free DNA simultaneously to detect and to localize multiple cancer types may enable early cancer detection and the potential to improve patient outcomes and reduce the burden of cancer.

Objective: To estimate the cancer-related cost of care after a cancer diagnosis among Medicare beneficiaries, by disease stage at diagnosis.

Methods: We used 2012-2016 data from the linked Surveillance, Epidemiology, and End Results (SEER) registry-Medicare claims database to examine cost of care among Medicare patients with a confirmed cancer—including hormone receptor (HR)-positive, HR-negative breast cancer, colon, esophagus, head and neck, kidney, liver, lung, lymphoid, ovarian, pancreatic, prostate, or stomach cancer—based on the International Classification of Diseases for Oncology, Third edition, histology codes reported in SEER. Patients contributed to the calculation of annual costs (years 1-5) using their observed time after diagnosis; thus, each annualized calculation consisted of a different sample. Patients were continuously enrolled in fee-for-service Medicare Part A or Part 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 613,639 Medicare beneficiaries with incident cancer diagnosis within 5 years (stage I, II, III, and IV: 26.9%, 31.2%, 14.4%, and 16.8%, respectively; 10.6% of patients lacked stage information). Across all 13 cancer cohorts (N = 6775-135,663), mean (standard deviation [SD]) age ranged from 68.0 (11.0) to 74.2 (10.0) years. In year 1, mean (SD) total costs for stage I diagnoses varied from $33,033 ($46,609) for prostate, to $129,254 ($142,600) for pancreatic cancer. Total costs increased by disease stage and reached $76,314 ($108,425) for prostate to $196,302 ($205,370) for liver cancer for stage IV diagnoses in year 1; stage IV total costs were 1.4 for pancreatic to 2.7 for HR-positive breast or kidney cancer times the stage I costs. Inpatient costs were the largest share of year 1 total costs for the majority of cancers, ranging from $5558 ($23,739) for HR-positive breast to $78,148 ($119,143) for pancreatic cancer for stage I diagnoses, and $37,399 ($90,065) for prostate to $123,416 ($183,116) for liver cancer for stage IV diagnoses. In years 2 to 5, the total costs were notably lower than in year 1, but continued to increase by disease stage.

Conclusions: Patients diagnosed at later stages of cancer have considerably higher costs of care than those diagnosed at earlier stages. Earlier cancer diagnosis may lead to more efficient treatment and decreased management cost.

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