nach oben

Erschienen in:

12.07.2017 | Epidemiology

Medical costs of treating breast cancer among younger Medicaid beneficiaries by stage at diagnosis

verfasst von: Justin G. Trogdon, Donatus U. Ekwueme, Diana Poehler, Cheryll C. Thomas, Katherine Reeder-Hayes, Benjamin T. Allaire

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 1/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Younger women (aged 18–44 years) diagnosed with breast cancer often face more aggressive tumors, higher treatment intensity, and lower survival rates than older women. In this study, we estimated incident breast cancer costs by stage at diagnosis and by race for younger women enrolled in Medicaid.

Methods

We analyzed cancer registry data linked to Medicaid claims in North Carolina from 2003 to 2008. We used Surveillance, Epidemiology, and End Results (SEER) Summary 2000 definitions for cancer stage. We split breast cancer patients into two cohorts: a younger and older group aged 18–44 and 45–64 years, respectively. We conducted a many-to-one match between patients with and without breast cancer using age, county, race, and Charlson Comorbidity Index. We calculated mean excess total cost of care between breast cancer and non-breast cancer patients.

Results

At diagnosis, younger women had a higher proportion of regional cancers than older women (49 vs. 42%) and lower proportions of localized cancers (44 vs. 50%) and distant cancers (7 vs. 9%). The excess costs of breast cancer (all stages) for younger and older women at 6 months after diagnosis were $37,114 [95% confidence interval (CI) = $35,769–38,459] and $28,026 (95% CI = $27,223–28,829), respectively. In the 6 months after diagnosis, the estimated excess cost was significantly higher to treat localized and regional cancer among younger women than among older women. There were no statistically significant differences in excess costs of breast cancer by race, but differences in treatment modality were present among younger Medicaid beneficiaries.

Conclusions

Younger breast cancer patients not only had a higher prevalence of late-stage cancer than older women, but also had higher within-stage excess costs.

Nur mit Berechtigung zugänglich

United States Cancer Statistics: 1999–2012 incidence and mortality web-based report. www.cdc.gov/uscs

Anders CK, Johnson R, Litton J, Phillips M, Bleyer A (2009) Breast cancer before age 40 years. Semin Oncol 36(3):237–249CrossRefPubMedPubMedCentral

Lee HB, Han W (2014) Unique features of young age breast cancer and its management. J Breast Cancer 17(4):301–307CrossRefPubMedPubMedCentral

Maggard MA, O’Connell JB, Lane KE, Liu JH, Etzioni DA, Ko CY (2003) Do young breast cancer patients have worse outcomes? J Surg Res 113(1):109–113CrossRefPubMed

Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H (2009) Breast cancer in young women: poor survival despite intensive treatment. PLoS ONE 4(11):e7695CrossRefPubMedPubMedCentral

Howard-Anderson J, Ganz PA, Bower JE, Stanton AL (2012) Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review. J Natl Cancer Inst 104(5):386–405CrossRefPubMed

Trivers KF, Fink AK, Partridge AH, Oktay K, Ginsburg ES, Li C, Pollack LA (2014) Estimates of young breast cancer survivors at risk for infertility in the U.S. Oncologist 19(8):814–822CrossRefPubMedPubMedCentral

Brown DS, Trogdon JG, Ekwueme DU, Chamiec-Case L, Guy GP, Tangka FK, Li C, Trivers KF, Rodriguez JL (2016) Health state utility impact of breast cancer in US women aged 18–44 years. Am J Prev Med 50(2):255–261CrossRefPubMed

Trogdon JG, Ekwueme DU, Chamiec-Case L, Guy GP (2016) Breast cancer in young women: health state utility impacts by race/ethnicity. Am J Prev Med 50(2):262–269CrossRefPubMed

10.

Allaire BT, Ekwueme DU, Guy GP, Li C, Tangka FK, Trivers KF, Sabatino SA, Rodriguez JL, Trogdon JG (2016) Medical care costs of breast cancer in privately insured women aged 18–44 years. Am J Prev Med 50(2):270–277CrossRefPubMed

11.

Ekwueme DU, Allaire BT, Guy GP, Arnold S, Trogdon JG (2016) Treatment costs of breast cancer among younger women aged 19–44 years enrolled in Medicaid. Am J Prev Med 50(2):278–285CrossRefPubMed

12.

Ekwueme DU, Trogdon JG, Khavjou OA, Guy GP (2016) Productivity costs associated with breast cancer among survivors aged 18–44 years. Am J Prev Med 50(2):286–294CrossRefPubMed

13.

Baker LC, Royalty AB (2000) Medicaid policy, physician behavior, and health care for the low-income population. J Hum Resour 35(3):22CrossRef

14.

Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY (2008) Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol 9(3):222–231CrossRefPubMed

15.

Shi R, Taylor H, McLarty J, Liu L, Mills G, Burton G (2015) Effects of payer status on breast cancer survival: a retrospective study. BMC Cancer 15:211CrossRefPubMedPubMedCentral

16.

Lipscomb J, Fleming ST, Trentham-Dietz A, Kimmick G, Wu XC, Morris CR, Zhang K, Smith RA, Anderson RT, Sabatino SA et al (2016) What predicts an advanced-stage diagnosis of breast cancer? sorting out the influence of method of detection, access to care, and biologic factors. Cancer Epidemiol Biomark Prev 25(4):613–623CrossRef

17.

O’Malley CD, Shema SJ, Clarke LS, Clarke CA, Perkins CI (2006) Medicaid status and stage at diagnosis of cervical cancer. Am J Public Health 96(12):2179–2185CrossRefPubMedPubMedCentral

18.

Subramanian S, Trogdon J, Ekwueme DU, Gardner JG, Whitmire JT, Rao C (2011) Cost of breast cancer treatment in Medicaid: implications for state programs providing coverage for low-income women. Med Care 49(1):89–95CrossRefPubMed

19.

IOM (2001) Coverage matters: insurance and health Care. National Academy of Press, Washington, DC

20.

Hassett MJ, Schymura MJ, Chen K, Boscoe FP, Gesten FC, Schrag D (2016) Variation in breast cancer care quality in New York and California based on race/ethnicity and Medicaid enrollment. Cancer 122(3):420–431CrossRefPubMed

21.

Grant SR, Walker GV, Koshy M, Shaitelman SF, Klopp AH, Frank SJ, Pugh TJ, Allen PK, Mahmood U (2015) Impact of insurance status on radiation treatment modality selection among potential candidates for prostate, breast, or gynecologic brachytherapy. Int J Radiat Oncol Biol Phys 93(5):968–975CrossRefPubMed

22.

Mobley LR, Subramanian S, Tangka FK, Hoover S, Wang J, Hall IJ, Singh SD (2016) Breast cancer screening among women with Medicaid, 2006–2008: a multilevel analysis. J Racial Ethn Health Dispar 4(3):446–454CrossRef

23.

Haji-Jama S, Gorey KM, Luginaah IN, Zou G, Hamm C, Holowaty EJ (2016) Disparities report: disparities among minority women with breast cancer living in impoverished areas of California. Cancer Control 23(2):157–162CrossRefPubMedPubMedCentral

24.

Akinyemiju TF, Vin-Raviv N, Chavez-Yenter D, Zhao X, Budhwani H (2015) Race/ethnicity and socio-economic differences in breast cancer surgery outcomes. Cancer Epidemiol 39(5):745–751CrossRefPubMed

25.

Shankaran V, Jolly S, Blough D, Ramsey SD (2012) Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol 30(14):1608–1614CrossRefPubMed

26.

Jagsi R, Pottow JA, Griffith KA, Bradley C, Hamilton AS, Graff J, Katz SJ, Hawley ST (2014) Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol 32(12):1269–1276CrossRefPubMedPubMedCentral

27.

Khanna R, Madhavan SS, Bhanegaonkar A, Remick SC (2011) Prevalence, healthcare utilization, and costs of breast cancer in a state Medicaid fee-for-service program. J Women’s Health 20(5):739–747CrossRef

28.

Sabik LM, Tarazi WW, Bradley CJ (2015) State Medicaid expansion decisions and disparities in women’s cancer screening. Am J Prev Med 48(1):98–103CrossRefPubMed

29.

Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94(7):490–496CrossRefPubMed

30.

Segel JE (2006) Cost-of-illness studies—a primer. RTI-UNC Center of Excellence in Health Promotion Economics, Chapel Hill, pp 1–39

31.

Blumen H, Fitch K, Polkus V (2016) Comparison of treatment costs for breast cancer, by tumor stage and type of service. Am Health Drug Benefits 9(1):23PubMedPubMedCentral

32.

Meyer AM, Olshan AF, Green L, Meyer A, Wheeler SB, Basch E, Carpenter WR (2014) Big data for population-based cancer research: the integrated cancer information and surveillance system. N C Med J 75(4):265–269PubMedPubMedCentral

33.

Warren JL, Yabroff KR, Meekins A, Topor M, Lamont EB, Brown ML (2008) Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst 100(12):888–897CrossRefPubMedPubMedCentral

34.

Reck J, Yalowich R (2016) Understanding medicaid claims and encounter data and their use in payment reform. In: National Academy for State Health Policy, pp 1–6

35.

Primary Care Case Management in North Carolina .https://www.cga.ct.gov/2008/rpt/2008-R-0622.htm

36.

Iacus SM, King G, Porro G (2011) Causal inference without balance checking: Coarsened exact matching. Polit Anal 20:1–24CrossRef

37.

Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251CrossRefPubMed

38.

Iacus SM, King G, Porro G (2009) CEM: software for coarsened exact matching. J Statis Softw 30:1–27

39.

Analysis USBoE: Table 1.1.9. Implicit Price Deflators for Gross Domestic Product. In

40.

Reeder-Hayes KE, Meyer AM, Dusetzina SB, Liu H, Wheeler SB (2014) Racial disparities in initiation of adjuvant endocrine therapy of early breast cancer. Breast Cancer Res Treat 145(3):743–751CrossRefPubMedPubMedCentral

41.

Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML (2011) Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 103(2):117–128CrossRefPubMedPubMedCentral

42.

Yabroff KR, Lamont EB, Mariotto A, Warren JL, Topor M, Meekins A, Brown ML (2008) Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst 100(9):630–641CrossRefPubMed

43.

44.

Bradley CJ, Given CW, Roberts C (2002) Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 94(7):490–496CrossRefPubMed

45.

Roetzheim RG, Gonzalez EC, Ferrante JM, Pal N, Van Durme DJ, Krischer JP (2000) Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer 89(11):2202–2213CrossRefPubMed

46.

Irwin DE, Masaquel A, Johnston S, Barnett B (2016) Adverse event-related costs for systemic metastatic breast cancer treatment among female Medicaid beneficiaries. J Med Econ 19(11):1027–1033CrossRefPubMed

47.

Ekwueme DU, Trogdon JG (2016) The economics of breast cancer in younger women in the U.S.: the present and future. Am J Prev Med 50(2):249–254CrossRefPubMed

48.

Breast Cancer Education and Awareness Requires Learning Young (EARLY) Act of 2009 H.R. 1740 S. In

Titel: Medical costs of treating breast cancer among younger Medicaid beneficiaries by stage at diagnosis
verfasst von: Justin G. Trogdon
Donatus U. Ekwueme
Diana Poehler
Cheryll C. Thomas
Katherine Reeder-Hayes
Benjamin T. Allaire
Publikationsdatum: 12.07.2017
Verlag: Springer US
Erschienen in: Breast Cancer Research and Treatment / Ausgabe 1/2017
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-017-4386-2

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Medical costs of treating breast cancer among younger Medicaid beneficiaries by stage at diagnosis