Computing the cost of care per day of breast cancer survivor care.

Abstract

10 Background: Cost of breast cancer survivor surveillance, of survivorship care and of variation in care practices are unknown. Furthermore, it is not known whether intense surveillance care adds value. We developed a method to measure the cost of surveillance to account for varying follow-up duration [cost of care per day (CCPD)], and explored the impact of surveillance cost on survival. Methods: We queried the Oncoshare database {Kurian et al Cancer 2014}, which amalgamates data from Stanford Health Care’s (SHC) electronic health record (EHR) (imaging, infused drugs, inpatient and outpatient facility and professional services), from the California Cancer Registry, and the Social Security Death Index. We included breast cancer patients diagnosed 2000-2014, Stages 0-III who had surgery, chemotherapy or radiation treatment at SHC, and who had more than two visits at SHC within 3 years of their treatment completion. We tallied Common Procedural Terminology (CPT©) codes assigned to each service, and mapped each CPT code to the corresponding code and date in the CMS Medicare fee schedule. For patients with breast cancer relapse, we explored the post-relapse survival of the costliest 20% compared with the other patients. Results: CCPD was $2.45 for care delivered at SHC. Among the three breast cancer subtypes (luminal, Her-2 over-expressed and triple negative) there was no difference in cost. Among patients who relapsed, those in the most expensive 20% CCPD had significantly shorter survival than other patients. The high-cost patients had more co-morbidity [cerebrovascular disease (4% for low cost vs 7% for high), chronic pulmonary disease (5% vs 10%), CHF (2% vs 7%), diabetes (4% vs 7%), liver disease (4% vs 9%)]. Conclusions: Cost of care per day (CCPD) is a useful metric to assess value of surveillance and survivorship care, and is also applicable to initial treatment and post-relapse care, to identify “positive deviants” ( those who have developed best practices) in high value care delivery. We captured only costs for treatment at SHC, and merging our data with claims data from 3rd party carriers could increase the accuracy and validity of the CCPD. We identified a model for further testing to reduce total spending for high-quality oncology care.