Table 1 Study characteristics of articles assessed for cost of cancer care
Number of studies / Percentage of studiesStudy setting / Study publication year
1995–1998 / 14 / 23.3
1999–2002 / 22 / 36.7
2003–2006 / 24 / 40.0
Geographic settinga
Single city / 12 / 20.0
Single state / 20 / 33.3
Multiple cities and/or states / 22 / 36.7
National / 7 / 11.7
Delivery settinga
Single institutions or clinic / 7 / 11.7
Network of institutions or clinics / 5 / 8.3
Integrated system / 13 / 21.7
Insurance network / 27 / 45.0
Other / 9 / 15.0
Health Insurance typea
Fee-for-service / 21 / 35.0
Managed Care / 11 / 18.3
Multiple types / 24 / 40.0
Health insurance type not reported / 5 / 8.3
Data source
SEER–Medicare / 12 / 20.0
Managed care / 11 / 18.3
MEDSTAT MarketScan / 4 / 6.7
Other / 33 / 55.0
Cancer patient characteristics / Cancer patient identificationa
Medical record review / 14 / 23.3
Registry / 26 / 43.3
Claims / 15 / 25.0
Other / 13 / 21.7
Tumor sitea
Breast / 21 / 35.0
Colorectal / 14 / 23.3
Lung / 12 / 20.0
Prostate / 16 / 26.7
Other / 19 / 31.7
Tumor stagea
AJCC I/II or localized / 29 / 48.3
AJCC III/IV or regional/distant / 24 / 40.0
Other / 8 / 13.3
Stage not reported / 19 / 31.7
Number of cancer patientsa
100–499 / 21 / 35.0
500–999 / 10 / 16.7
1,000–4,999 / 10 / 16.7
5,000–9,999 / 7 / 11.7
> 10,000 / 13 / 21.7
Patient age groups (years) a
<40 / 14 / 23.3
40–64 / 18 / 30.0
65 / 33 / 55.0
Mean age <65 / 13 / 21.7
Mean age 65 / 9 / 15.0
Patient ages not-stated / 4 / 6.7
Characteristics of cost data / Source of cost dataa
Claims / 32 / 53.3
Billing systems/cost accounting systems / 18 / 30.0
Other / 14 / 23.3
Measurement of costa
Charges / 11 / 18.3
Payments / 26 / 43.3
Cost / 17 / 28.3
Expenditures / 4 / 6.7
Other / 3 / 5.0
Study methods / Phase of carea
Pre-diagnosis / 3 / 5.0
Initial treatment of incident disease / 18 / 30.0
Continuing or monitoring / 8 / 13.3
Last year of life / 19 / 31.7
All phases together (prevalent cases) / 21 / 35.0
Long-term/lifetime costs / 18 / 30.0
Other / 7 / 11.7
Comparison groupa
Non-cancer controls / 23 / 38.3
Other comparison group / 6 / 10.0
No comparison group / 32 / 53.3
Use of price adjustersa
Time adjusters / 33 / 55.0
Other / 5 / 8.3
Not reported / 23 / 38.3
Method for addressing censored/missing dataa
Inclusion of complete sample only / 7 / 11.7
Kaplan-Meier sample-average (KMSA) / 11 / 18.3
Phase of care approach / 7 / 11.7
Other / 14 / 23.3
Not reported / 27 / 45.0
Methods for addressing skewed cost distributiona
Log transformation / 20 / 33.3
Two-part models / 8 / 13.3
Large sample size (assume normal distribution) / 16 / 26.7
Other / 5 / 8.3
Not reported / 19 / 31.7
Study limitations / Study setting – limited generalizabilitya
Limited patient age distribution in data source / 39 / 65.0
Geographically limited/single institution / 32 / 53.3
Single type of health insurance / 31 / 51.7
Patient characteristics – potential misclassification
Patient identification not clearly specified / 24 / 40.0
Continuous enrollment in insurance plan not stated / 30 / 50.0
Cost data – potential misclassification
Measurement of cost not specified / 4 / 6.7
Use of charges as proxy for costs / 11 / 18.3
Study methods – limited interpretabilitya
Phase of care definitions unclear / 13 / 21.7
Analysis of cost data not clear / 30 / 50.0
Analysis of censored/missing data not addressed / 27 / 45.0
aStudies may be included in more than one category.
3
Table 2 Costs of cancer care among prevalent cancer patients.
Tumor Site / Study / Setting / Sample characteristics / Components of care after identification / FindingsAll cancers / Howard, 2004 / MEPS / 842 patients aged <65 years identified from encounters during 1996–1999 / All care / Total cancer- related spending in the US was $20.08 billion in 2001 dollars during 1996–1999.
Howard, 2004 / Medstat MarketScan / 41,756 patients aged <65 years identified from claims during 1999 / All care / Total cancer-related payments in the US were $32.82 billion in 2001 dollars during 1999.
Langa, 2004 / AHEAD study / 988 adults aged 70 years reporting a history of cancer in 1995 / Out of pocket in 1 year / Cancer-related out of pocket spending for patients with cancer history and undergoing treatment were $240 and $670 in 1995 dollars.
Thorpe, 2003 / MEPS / 1,383 adults all ages identified from in- and out-patient records during 1996–1999 / All care / Total spending was $6,115 in 6 months after identification. Spending for uninsured patients was lower in every category except out of pocket. All in 2001 dollars.
Fishman, 1997 / SEER–GHC / 6,116 patients of all ages identified from registry who were treated during 1992 / All care / Total costs were $8,992. Total costs for men and women were $9,264 and $8,782. All in 1992 dollars.
Breast / Rao, 2004 / Medicare 5% sample / 397 patients aged 65 years with code for metastases identified from claims, 1997 / All care / Total payments over an average of 16.2 months were $35,164. Year of dollars not reported.
Arozullah, 2004 / Cancer Center / 156 women aged 29 years, all stages diagnosed 1997–2002 / 3 month out of pocket / Total mean monthly out of pocket expenditures for a 3 months were $597. Year of dollars not reported.
Mullins, 2004 / Medicaid (MD) / 2,572 patients identified from claims during 1999–2000. Patient age not stated / Ambulatory care / Total mean ambulatory payments were $1,135. Year of dollars not reported.
Sasser, 2005 / Employer claims / 555 patients aged 50-64 identified from claims during 1998–2000 / All care / Annual cancer related payments were $13,925. Cancer related inpatient, outpatient, and prescription drug payments were $2,376, $6,308, and $1,493 in 2000 dollars.
Ray, 2000 / KP–Northern CA / 12,155 patients of all ages identified from billing during 1995–1996 / All care / Total annual adjusted and unadjusted costs were $3,414 and $ 6,672 in 1996 dollars.
Colorectal / Paramore, 2006 / PharMetrics Database / 699 patients with a code for metastases identified from claims during 1998–2004 / All care / Cancer-related payments over average of 12.8 months were $97,031 in 2005 dollars.
Chang, 2004 / Medstat MarketScan / 2,858 patients identified from claims during 1999–2000 / All care / Cancer –related payments were $3,742 per month and $30,939 over study. Year of dollars not reported.
Mullins, 2004 / Medicaid (MD) / 1,904 patients identified from claims during 1999–2000. Patient age not stated. / Ambulatory care / Total mean ambulatory payments were $946. Year of dollars not reported.
Ray, 2000 / KP–Northern CA / 2,613 patients of all ages identified from billing during 1995–1996 / All care / Total annual adjusted and unadjusted cost per capita was $10,506 and $15,253 in 1996 dollars.
Seifeldin, 1999 / HCUP / 951,016 hospital discharges colorectal cancer during 1991–1994 / Hospital care / Mean charge per admission was $19,995 in 1991–1994 dollars.
Lung / Kutikova, 2005 / Medstat MarketScan / 2040 patients identified from claims during 1999–2000 / All care / Cancer-related payments over an average of 9.3 months were $42,990. Year of dollars not reported.
Chang, 2004 / Medstat MarketScan / 2,038 patients identified from claims, 1999–2000 / All care / Cancer –related payments were $6,181 per month and $42,990 over study. Year of dollars not reported.
Ray, 2000 / KP–Northern CA / 3,145 patients of all ages identified from billing during 1995–1996 / All care / Total annual adjusted and unadjusted cost per capita was $8,612 and $16,243 in 1996 dollars.
Prostate / Mullins, 2004 / Medicaid (MD) / 1,281 men identified from claims during 1999 –2000. Patient age not stated / Ambulatory care / Total mean ambulatory payments were $1,211. Year of dollars not reported.
Chang, 2004 / Medstat MarketScan / 5,250 men identified from claims during 1999–2000 / All care / Cancer –related payments were $1,844 per month and $17,968 over study. Year of dollars not reported.
Max, 2002 / Hospital Discharge (CA) / 9,043 discharges with primary diagnosis and 12,492 discharges with secondary diagnosis (mean age of 65 years) identified in 1998 / Hospital care / Mean total costs for hospitalization with primary and secondary prostate cancer diagnosis were $6,939 and $3,388 in 1998 dollars.
Brandeis, 2000 / Medicare 5% sample / 10,017 men aged 65 years identified from claims during 199 –1996 / Cancer care in 1 year / Mean cancer charges for RP and radiation were $19,019 and $15,937. Year of dollars not reported.
Ray, 2000 / KP–Northern CA / 8,728 men of all ages identified from billing during 1995–1996 / All care / Total annual adjusted and unadjusted cost per capita was $2,337 and $6,831 in 1996 dollars.
Benoit, 1998 / Hospital (PA) / 181 men aged 41–76 years identified from medical records during 1995–1996 / Hospital care / Total mean costs for cryosurgical ablation and RP were $4,150 and $5,660. Year of dollars not reported.
Litwin, 1998 / Medicare 5% sample / 5,016 men aged > 65years identified from claims during 1991–1993 / All care / Total mean payments for RP ranged from $6,702 (1991) to $7,179 (1992). Dollars not standardized.
Kramolowsky, 1995 / Five community hospitals (VA) / 625 men mean age 65 years identified as having RP during 1991–1993 / Hospital care / Total hospital charges for RP in 1991–1992 and 1992–1993 were $17,650 and $15,186. Year of dollars not reported.
Total costs reflect all services received by cancer patients. Cancer-related costs reflect either the cost of services presumed to be related to cancer treatment or the net cost of all services among cancer patients compared to similar individuals without cancer. Abbreviations: AHEAD, Asset and Health Dynamics Survey; BCS, breast conserving surgery; GHC, Group Health Cooperative; HCUP, Healthcare Cost and Utilization Project; KP, Kaiser Permanente; MEPS, Medical Expenditure Panel Survey; MRM = modified radical mastectomy; RP, radical prostatectomy
Table 3 Costs of breast cancer care.
Pre-diagnosis / Fireman et al. (1997)13
[AU: This format will be replicated for the remaining tables] / SEER-KP Northern CA / 3,824 women of all ages, all stages diagnosed 1987–1991, use 1987–1991 / All care in 1 month before diagnosis / Mean total costs were $387 in 1992 dollars.
Initial Phase of Care / Lamerato, 2006 / Registry- HFHS / 1595 women aged 19 years, stage I/II diagnosed 1996–2002, charges 1996–2004 / All care in 6 months after diagnosis / Mean total charges for women with and without recurrence were $38,165 and $41,345 in 2003 dollars.
Oestreicher, 2005 / SEER-Blue Shield / 1239 women aged <69 years, local or regional diagnosed 1996–2000, claims 1996–2000 / All care in 9 months after diagnosis / Mean cancer related payments for women receiving and not receiving chemotherapy were $43,282 and $20,264 in 2003 dollars.
Warren, 2001 / SEER-Medicare / 28,916 women aged 65 years, stage I/II diagnosed 1983–1996, claims 1990–1998 / All care in 6 months after diagnosis / Mean cancer-related monthly payments for BCS+RT and MRM were $1,837 and $1,375 in 1998 dollars.
Barlow, 2001 / SEER-GHC / 1675 women aged 35 years, stage I/II diagnosed 1990–1997, cost data 1990–1998 / All care in year after diagnosis / Mean cancer-related costs for mastectomy, BCS + RT, and BCS+RT+adjuvant were $12,621, $13,031, and $17,106. All in 1998 dollars.
Given, 2001 / Registry- Medicare / 205 women aged 65 years, all stages diagnosed 1993–1997, claims 1993–1997 / Surgery-related 6 weeks after diagnosis / Mean total charges for BCS, BCS plus mastectomy, and mastectomy were $5,237, $12,151, and $9,418 in 1997 dollars.
Penberthy, 1999 / Registry- Medicare / 1952 women aged 65 years, all stages diagnosed 1985–1988, claims 1985–1989 / All care in year after diagnosis / Mean total payments for surviving and not surviving the year were $6,781 and $14,771 in 1997 dollars
Fireman, 1997 / SEER-KP Northern CA / 3,824 women of all ages, all stages diagnosed 1987–1991, use 1987–1991 / All care 6 months after diagnosis / Mean total costs were $14,737 in 1992 dollars.
Legorreta, 1996 / US Health- PA / 200 women aged 20 years, all stages diagnosed 1989, costs 1989–1993 / In- and out-patient in year after diagnosis / Mean total payments with and without screening were $15,100; and $19,000 in 1993 dollars.
Riley, 1995 / SEER-Medicare / 24,995 women aged 65 years, all stages diagnosed 1984–1989, claims 1984–1990 / All care month before and 6 months after diagnosis / Mean total payments were $8,913 in 1990 dollars. Payments higher in younger age groups and higher stage.
Taplin, 1995 / SEER -GHC / 645 women aged 35 years, all stages diagnosed 1990–1991, costs 1990–1991 / All care in 6 months after diagnosis / Total and cancer related costs were $10,813 and $9,353 in 1992 dollars.
Contin-uing Phase of Care / Lamerato, 2006 / Registry- HFHS / 1478 women aged 19 years, stage I/II diagnosed 1996–2002, charges 1996–2004 / All care per 3 months / Mean total charges for women with and without recurrence were $2,564 and $1,228 in 2003 dollars.
Warren, 2001 / SEER-Medicare / 48,171 women aged 65 years, stage I or II diagnosed 1983–1996, claims 1990–1998 / All care per month / Mean cancer-related monthly payments for BCS+RT and MRM were $106 and $111 in 1998 dollars
Fireman, 1997 / SEER-KP Northern CA / 7,052 women of all ages, all stages diagnosed 1973–1991, use 1987–1991 / All care per 6 months / Mean total costs were $2,245 in 1992 dollars.