BackgroundWe studied trends in lung cancer treatment cost over time by phase of care, treatment strategy, age, stage at diagnosis, and histology.MethodsUsing the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database for years 1998‐2013, we allocated total and patient‐liability costs into the following phases of care for 145 988 lung cancer patients: prediagnosis, staging, surgery, initial, continuing, and terminal. Patients served as self‐controls to determine cancer‐attributable costs based on individual precancer diagnosis healthcare costs. We fit linear regression models to determine cost by age and calendar year for each stage at diagnosis, histology, and treatment strategy and presented all costs in 2017 US dollars.ResultsMonthly healthcare costs prior to lung cancer diagnosis were $861 for a 70 years old in 2017 and rose by an average of $17 per year (P < 0.001). Surgery in 2017 cost $30 096, decreasing by $257 per year (P = 0.007). Chemotherapy and radiation costs remained stable or increased for most stage and histology groups, ranging from $4242 to $8287 per month during the initial six months of care. Costs during the final six months of life decreased for those who died of lung cancer or other causes.ConclusionsCost‐effectiveness analyses of lung cancer control interventions in the United States have been using outdated and incomplete treatment cost estimates. Our cost estimates enable updated cost‐effectiveness analyses to determine the benefit of lung cancer control from a health economics point of view.

No abstract

Background Our study analyzed disparities in utilization and phase-specific costs of care among older colorectal cancer patients in the United States. We also estimated the phase-specific costs by cancer type, stage at diagnosis, and treatment modality. Methods We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 66 or older diagnosed with colon or rectal cancer between 2000-2013, with follow-up to death or December 31, 2014. We divided the patient's experience into separate phases of care: staging or surgery, initial, continuing, and terminal. We calculated total, cancer-attributable, and patient-liability costs. We fit logistic regression models to determine predictors of treatment receipt and fit linear regression models to determine relative costs. All costs are reported in 2019 US dollars. Results Our cohort included 90,023 colon cancer patients and 25,581 rectal cancer patients. After controlling for patient and clinical characteristics, Non-Hispanic Blacks were less likely to receive treatment but were more likely to have higher cancer-attributable costs within different phases of care. Overall, in both the colon and rectal cancer cohorts, mean monthly cost estimates were highest in the terminal phase, next highest in the staging phase, decreased in the initial phase, and were lowest in the continuing phase. Conclusions Racial/ethnic disparities in treatment utilization and costs persist among colorectal cancer patients. Additionally, colorectal cancer costs are substantial and vary widely among stages and treatment modalities. This study provides information regarding cost and treatment

Background The end‐of‐life period is a crucial time in lung cancer care. To have a better understanding of the racial‐ethnic disparities in health care expenditures, access, and quality, we evaluated these disparities specifically in the end‐of‐life period for patients with lung cancer in the U.S. Materials and Methods We used the Surveillance, Epidemiology, and End Results (SEER)‐Medicare database to analyze characteristics of lung cancer care among those diagnosed between the years 2000 and 2011. Linear and logistic regression models were constructed to measure racial‐ethnic disparities in end‐of‐life care cost and utilization among non‐Hispanic (NH) Asian, NH black, Hispanic, and NH white patients while controlling for other risk factors such as age, sex, and SEER geographic region. Results Total costs and hospital utilization were, on average, greater among racial‐ethnic minorities compared with NH white patients in the last month of life. Among patients with NSCLC, the relative total costs were 1.27 (95% confidence interval [CI], 1.21–1.33) for NH black patients, 1.36 (95% CI, 1.25–1.49) for NH Asian patients, and 1.21 (95% CI, 1.07–1.38) for Hispanic patients. Additionally, the odds of being admitted to a hospital for NH black, NH Asian, and Hispanic patients were 1.22 (95% CI, 1.15–1.30), 1.47 (95% CI, 1.32–1.63), and 1.18 (95% CI, 1.01–1.38) times that of NH white patients, respectively. Similar results were found for patients with SCLC. Conclusion Minority patients with lung cancer have significantly higher end‐of‐life medical expenditures than NH white patients, which may be explained by a greater intensity of care in the end‐of‐life period. Implications for Practice This study investigated racial‐ethnic disparities in the cost and utilization of medical care among lung cancer patients during the end‐of‐life period. Compared with non‐Hispanic white patients, racial‐ethnic minority patients were more likely to receive intensive care in their final month of life and had statistically significantly higher end‐of‐life care costs. The findings of this study may lead to a better understanding of the racial‐ethnic disparities in end‐of‐life care, which can better inform future end‐of‐life interventions and help health care providers develop less intensive and more equitable care, such as culturally competent advanced care planning programs, for all patients.