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Burden Of US Cancer Care Is Billions When You Add Up Patient Time




 


www.JNCI.OXFORDJOURNALS.org

GDO Report - Catharine Paddock, . Robin Yabroff, William W. Davis, Elizabeth B. Lamont, Angela Fahey, Marie Topor, Martin L. Brown and Joan L. Warren

OXFORD, UK - A new type of study into the cost of patients' time associated with cancer care in the US suggests that the annual figure could exceed 2 billion dollars for the first year following a diagnosis.

The study is published in today's issue of the Journal of the National Cancer Institute.

The researchers, led by Dr Yabroff of the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI), used data covering 11 types of cancer from 760,000 patients whose records are in the Surveillance, Epidemiology, and End Results Medicare database. The records spanned 1995 to 2001. They also looked at information on 1.1 million Medicare members who did not have cancer for comparison.

The key question they tried to answer, in different ways, was how much extra time does having treatments for cancer, as opposed to non-cancer treatments, cost the average patient? This extra time they termed "net hours". They estimated figures based on net hours and net costs by multiplying the hours by the median US wage rate (using the 2002 value of 15.23 dollars per hour).

They then looked at the database records and estimated the time that each patient spent actively waiting to be seen by a doctor or in a queue to receive treatment, for example in a hospital or emergency room. Time spent recovering from treatment at home was not included. Time spent in hospital before and after a treatment was included, as was time spent travelling to and from the treatment.

This type of study has not been done before - most estimates of cancer care focus on the direct costs of medical treatment and drugs.

One of the most revealing results was the wide variation in the costs among the 11 types of cancer, and also the influence of early versus late diagnosis.

Patient Time Costs Associated With Cancer Care
GDO Report - K. Robin Yabroff, William W. Davis, Elizabeth B. Lamont, Angela Fahey, Marie Topor, Martin L. Brown and Joan L. Warren

Affiliations of authors: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY, WWD, MLB, JLW); Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA (EBL); Information Management Systems, Inc, Rockville, MD (AF, MT)

Correspondence to: K. Robin Yabroff, PhD, MBA, Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Rm. 4005, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892

BACKGROUND: Although costs of medical care for cancer have been investigated extensively, patient time costs associated with cancer care have rarely been estimated systematically. In this study, we estimated patient time costs associated with cancer care in patients aged 65 years and older in the United States.

METHODS: We identified 763 527 patients with breast, colorectal, corpus uteri, gastric, head and neck, lung, melanoma of the skin, ovary, prostate, renal, and urinary bladder cancers from linked Surveillance, Epidemiology, and End Results–Medicare files and 1 145 159 noncancer control subjects among Medicare enrollees who were matched by sex, age-group, and geographic location. Frequency of service use was calculated by category for patients and control subjects using Medicare claims data from 1995 to 2001. For each service category, time estimates were combined with service frequency and an hourly value of patient time. Net patient time costs were summed in the initial, continuing, and last-year-of-life phases of care for each tumor site. Net time cost estimates for the initial phase of care were applied to national estimates of numbers of new cancers in 2005 to obtain national time costs for the initial phase of care.

RESULTS: Net patient time costs during the initial phase of care ranged from $271 (95% confidence interval [CI] = $213 to $329) and $842 (95% CI = $806 to $878) for melanoma of the skin and prostate cancer, respectively, to $5348 (95% CI = $4978 to $5718) and $5605 (95% CI = $5273 to $5937) for gastric and ovarian cancers, respectively. Net patient time costs for care during the last year of life ranged from $1509 (95% CI = $1343 to $1675) for melanoma of the skin to $7799 (95% CI = $7433 to $8165), $7435 (95% CI = $7207 to $7663), and $7388 (95% CI = $7018 to $7758) for gastric, lung, and ovarian cancers, respectively. In 2005, patient time costs for the initial phase of care were $2.3 billion.

CONCLUSIONS: Patient time costs for cancer care in the United States are substantial and vary by tumor site and phase of care, likely reflecting differences in stage at diagnosis and availability and intensity of treatment.

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CONTEXT AND CAVEATS
Prior knowledge
Most estimates for costs of cancer care are based on costs of medical treatments. The costs associated with patient time spent travelling to and from care, waiting for, and receiving care are rarely reported.

Study design
Estimates of medical service use in US cancer patients and similar non-cancer patients aged 65 years and older based on Medicare claims data were combined with service-specific time estimates from national surveys and an hourly value of time.

Contribution
Patient time costs vary widely by cancer type and phase of care. From the estimated number of patients diagnosed with cancer in 2005 in the US, the estimated patient time cost during the first year of treatment for all 11 types of cancer examined was $2.3 billion.

Implications
Costs of time associated with medical care for cancer patients are substantial. Differences observed among cancer type and phase of care are likely due to differences in stage at diagnosis and availability and intensity of treatment.

Limitations
The authors used data from Medicare claims and national surveys to calculate time estimates rather than direct measurement for most services. Although Medicare claims accurately record types of treatment received and duration of hospitalization, they do not provide hourly estimates of treatment duration or travel and waiting time. Survey data based on national averages may underestimate time spent by cancer patients travelling, waiting, and receiving care.
 


 

For example, compared to similar people receiving non-cancer treatments, the net time (i.e. additional) spent by patients in cancer care ranged from nearly 18 hours for melanoma to over 350 hours for gastric and ovarian cancer.

And, in the first 12 months following a diagnosis, gastric and ovarian cancers had the highest average hospitalization time (21.1 and 20.8 days respectively). The shortest times were for patients with melanoma, prostate and breast cancer (2.2, 3.8 and 4.0 days respectively).

Applying the median wage rate to the time spent in the first 12 months following diagnosis, the net patient time cost from 271 dollars for melanoma to over 5,000 dollars for gastric and ovarian cancers.

The researchers also found that the earlier a cancer was diagnosed, the less treatment required and the lower the patient time cost.

Talking about the national burden, the NCI researchers said that in 2005 "the estimated cost for the initial phase of care alone was approximately $2.3 billion".

The NCI team hope that when added to the direct and indirect costs of medical care and drugs these figures will help policy makers understand more clearly the nature of the cancer care burden in the country.

At first glance, using a monetary basis as a way to compare the costs to the patient of having one as opposed to another type of cancer, or not having cancer at all but some other disease seems a pointless academic exercise - what about the enormous emotional cost?

The researchers acknowledge this and point to the fact that with this kind of measure it is possible to compare, for the first time from the patients' perspective, the "burden" that different treatments represent, the differences between phases of care, between early and late diagnosis, and the availability and intensity of treatment.

 

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