Treatment Costs of Advanced Cancer: Variation in Costs for Stage IV vs. Recurrent Breast, Colorectal,Lung, and Prostate Cancers

Clin Med Res. 2013 Sep;11(3):129.

PS1-26: Treatment Costs of Advanced Cancer: Variation in Costs for Stage IV vs. Recurrent Breast, Colorectal,Lung, and Prostate Cancers.

Ritzwoller D, O'Keeffe-Rosetti M, Carroll N, Hornbrook M, Fishman P.

Abstract

Background/Aims 

Previous studies have described the variation in utilization and costs associated with cancer patients diagnosed at late stage vs. early stage. Other studies have described the high cost of cancer care in the terminal phase. Little is known regarding variation of costs of advancedcancer care between patients diagnosed de novo with stage IV cancer versus those with recurrent metastatic cancer that develops after definitive therapy for early stage disease and a period of disease-free survival. Our aim is to compare total monthly medical care costs and resource use during the year after development of metastatic disease among patients presenting with stage IV disease and those with metastatic recurrence, using data from two CRN sites with tumor registries that capture recurrence, adjusting for age and non-cancer comorbidity. 

Methods 

Patients aged 21 years and older with stage IV or metastatic recurrent breast, colorectal, lung, or prostate cancer diagnosed between 2000-2007 at two CRN sites were included in the analysis. Patients were followed for twelve months following diagnosis date (or through the end of 2008, or death, or disenrollment). Patient characteristics, comorbidities, and mortality were obtained from the Virtual Data Warehouse (VDW). Estimates of costs were derived from the 'HMO Costing Algorithm' by adapting these systems to assign real (deflated) costs to utilization data as represented in VDW encounter and procedure files. Descriptive statistics and regression analyses were used to compare costs and resource use between cohorts in each data set. 

Results 

383 breast, 752 colorectal, 1,463 lung, and 364 prostate cancer patients were identified with stage IV or metastatic recurrent disease. Forty percent of patients were age <65 years. Differences in age at diagnosis, and the modified Charlson-Deyo comorbidity index for patients with de novo vs. recurrent disease varied by cancer site. Average total monthly costs were significantly higher for stage IV cases relative to recurrent cases, except for prostatecancer cases. The cost differential (stage IV - recurrent) was the highest for breast cancer cases at $1,847. 

Conclusions 

The findings from this analysis could have significant clinical and policy relevance related to the cost implications of treating advanced cancer.