Cost of Care for Elderly Cancer Patients in the United States

TLDR

Accurate cost estimates for cancer care are essential for national cancer policy planning. The study estimated net costs for 718,907 elderly cancer patients across 18 common cancers and other sites using SEER‑Medicare data, matching each patient to non‑cancer controls by sex, age, location, and care phase, and calculating costs for initial, continuing, and last‑year phases from 1999‑2003 claims. Five‑year net costs ranged from <$20,000 for breast cancer or melanoma to >$40,000 for brain, esophageal, gastric, ovarian cancers or lymphoma, with an aggregate Medicare cost of about $21.1 billion in 2004, highest for lung, colorectal, and prostate cancers.

Abstract

Timely estimates of the costs of care for cancer patients are an important element in the formulation of national cancer programs and policies. We estimated net costs of care for elderly cancer patients in the United States for the 18 most prevalent cancers and for all other tumor sites combined.We used Surveillance, Epidemiology, and End Results-Medicare files to identify 718,907 cancer patients and 1,623,651 noncancer control subjects. Within each tumor site, noncancer control subjects were matched to patients by sex, age group, geographic location, and phase of care (ie, initial, continuing, and last year of life). Costs of care were estimated for each phase by use of Medicare claims data from January 1, 1999, through December 31, 2003. Per-patient net costs of care were applied to the 5-year survival of cancer patients by phase of care to estimate 5-year costs of care and extrapolated to the elderly US Medicare population diagnosed with cancer in 2004.Across tumor sites, mean net costs of care were highest in the initial and last year of life phases of care and lowest in the continuing phase. Mean 5-year net costs varied widely, from less than $20,000 for patients with breast cancer or melanoma of the skin to more than $40,000 for patients with brain or other nervous system, esophageal, gastric, or ovarian cancers or lymphoma. For elderly cancer patients diagnosed in 2004, aggregate 5-year net costs of care to Medicare were estimated to be approximately $21.1 billion. Costs to Medicare were highest for lung, colorectal, and prostate cancers, reflecting underlying incidence, stage distribution at diagnosis, survival, and phase-specific costs for these tumor sites.The costs of cancer care to Medicare are substantial and vary by tumor site, phase of care, stage at diagnosis, and survival.