The Cost of Initial Care for Medicare Patients With Advanced Ovarian Cancer

Urban, Renata R.; He, Hao; Alfonso-Cristancho, Rafael; Hardesty, Melissa M.; Goff, Barbara A.

doi:10.6004/jnccn.2016.0049

Cited by 33 publications

(24 citation statements)

References 26 publications

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“…The mean payments for Medicare beneficiaries with ovarian cancer within the first year of diagnosis was $65,908, Treatment with guideline concordant care was associated with lower costs in this cohort. 8 These findings are in line with our data in which payments of $93,000 within the first year of diagnosis for commercially insured women with ovarian cancer.…”

Section: Discussionsupporting

confidence: 88%

“…6–9 A recent study of Medicare beneficiaries estimated that the mean cost of care during the first year after diagnosis was approximately $66,000. 8 Estimates of how these costs are shared by patients are limited. The objective of the study was to examine the cost of care during the first year after diagnosis, to estimate the sources of cost, and to investigate the out-of-pocket costs that women with ovarian cancer experience.…”

Section: Introductionmentioning

confidence: 99%

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Cost of Care for the Initial Management of Ovarian Cancer

Bercow

Chen

Chatterjee

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To examine the cost of care during the first year after a diagnosis of ovarian cancer, estimate the sources of cost, and explore the out-of-pocket costs. Methods We performed a retrospective, cohort study of women with ovarian cancer diagnosed from 2009–2012 who underwent both surgery using the Truven Health MarketScan database. This database is comprised of patients covered by commercial insurance sponsored by over 100 employers in the United States. Medical expenditures, including physician reimbursement, for a 12-month period beginning on the date of surgery were estimated. All payments were examined, including out-of-pocket costs for patients. Payments were divided into expenditures for inpatient care, outpatient care (including chemotherapy), and outpatient drug costs. The 12-month treatment period was divided into 3 phases: surgery-30 days (operative period), 1–6 months (adjuvant therapy), and 6–12 months after surgery. The primary outcome was the overall cost of care within the first year of diagnosis of ovarian cancer, while secondary outcomes included assessment of factors associated with cost. Results A total of 26,548 women with ovarian cancer who underwent surgery were identified. After exclusion of patients with incomplete insurance enrollment/coverage, those who did not undergo chemotherapy, and those with capitated plans, our cohort consisted of 5,031 women. The median total medical expenditures per patient during the first year after the index procedure was $93,632 (interquartile range [IQR] $62,319–140,140). Inpatient services accounted for $30,708 (IQR, $20,102–51,107; 37.8%) in expenditures, outpatient services $52,700 (IQR, $31,210–83,206; 58.3%) and outpatient drug costs $1,814 (IQR, $603–4,402; 3.8%). The median out-of-pocket expense was $2988 (IQR, $1649–5088). This included $1509 (IQR, $705–2878) for outpatient services, $589 (IQR, $3–1715) for inpatient services, and $351 (IQR, $149–656) for outpatient drug costs. Conclusion The average cost of care for women with ovarian cancer in the first year after surgery is approximately $100,000. Patients bear approximately 3% of these costs in the form of out-of-pocket expenses.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Cost of Care for the Initial Management of Ovarian Cancer

Bercow

Chen

Chatterjee

et al. 2017

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

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“…For example, when considering costs from a societal perspective, one study reported that an estimated $2.5 billion was spent in 2010 for 10 common chemotherapies that were used in discordance with NCCN recommendations. 17 Similarly, in a SEER-Medicare analysis of almost 10,000 patients with ovarian cancer, Urban et al 18 found $7,500 higher Medicare spending for patients receiving guideline-discordant chemotherapy and surgery versus for concordant treatment in the first year after diagnosis. Although these and other studies have shown associations between guideline discordance and increased payer costs, patients themselves are largely unaware of and indifferent to payer or societal care costs outside of their immediate responsibility.…”

Section: Discussionmentioning

confidence: 99%

Guideline Discordance and Patient Cost Responsibility in Medicare Beneficiaries With Metastatic Breast Cancer

Williams¹,

Azuero²,

Kenzik

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Treatment for metastatic breast cancer (MBC) that is not concordant with the NCCN Guidelines for Breast Cancer has been associated with higher healthcare utilization and payer costs. However, a significant knowledge gap exists regarding the impact of guideline-discordant care on patient cost responsibility. This study examined this question among patients with MBC in the year postdiagnosis. Methods: This retrospective cohort study used data from the SEER-Medicare linked database from 2000 through 2013. Guideline discordance, defined by year-specific NCCN Guidelines, was assessed for first-line antineoplastic treatment and grouped into discrete categories. Patient cost responsibility (deductibles, coinsurance, copayments) in women with MBC were summed for all medical care received in the year postdiagnosis. The difference in patient cost responsibility by guideline discordance status was estimated using linear mixed-effect models. Results: Of 3,709 patients with MBC surviving at least 1 year postdiagnosis, 17.6% (n=651) received guideline-discordant treatment. Median cost responsibility in the year postdiagnosis for patients receiving guideline-discordant treatment was $7,421 (interquartile range [IQR], $4,359–$12,983) versus $5,171 (IQR, $3,006–$8,483) for those receiving guideline-concordant care. In adjusted models, guideline-discordant treatment was significantly associated with $1,841 higher patient costs in the first year from index diagnosis date (95% CI, $1,280–$2,401) compared with guideline-concordant care. Patient cost responsibility differed by category of guideline discordance, with those receiving nonapproved bevacizumab having the highest cost responsibility (β=$3,330; 95% CI, $1,711–$4,948). Conclusions: Deviations from current treatment guidelines may have implications on patient healthcare cost responsibility. Additional research is needed to fully understand the mechanisms underlying how guideline deviation leads to greater costs for patients with MBC.

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“…Receipt of non-NCCN guideline-consistent care has previously been shown to be an independent predictor of diminished overall survival in women with ovarian cancer [21]. Additionally, non-NCCN guideline-consistent care has been associated with greater overall costs for the treatment of women with ovarian cancer [30]. Guideline-consistent care provides the definition of value in healthcare with both improved outcomes and lower costs.…”

Section: Discussionmentioning

confidence: 99%

Disparities in treatment and survival among elderly ovarian cancer patients

Taylor

Harrison

et al. 2018

Gynecologic Oncology

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Objective. To determine correlation between race and receipt of optimal treatment for ovarian cancer and the impact of this on overall survival. Methods. Using SEER-linked Medicare database, women 66 and older diagnosed with advanced ovarian cancer between 2002 and 2011 were identified. Patients with unclear histology, diagnosed on autopsy and without Medicare Parts A and B were excluded. We used Chi-square test for categorical variables, F test for continuous variables, and multivariable logistic regression to identify characteristics associated with receipt of surgery and chemotherapy. Kaplan–Meier analysis was used to compare overall survival rates. Cox Proportional Hazards regression was performed to identify factors associated with 5-year survival. Results. 9016 ovarian cancer patients were included. 2638 had primary chemotherapy, 4854 had primary surgery, and 1524 had no treatment. 7653 (84.9%) were white, 572 (6.3%) black, 479 (5.3%) Hispanic, and 312 (3.5%) were of other race/ethnicity. More white patients (57.2%) received both chemotherapy and surgery compared to black (39.9%), Hispanic (48.9%), or other (54.2%) (p < .001). Receipt of either only surgery or chemotherapy, or receipt of neither, resulted in higher risk of death when compared to receipt of both. On multivariable analysis, black (OR 0.58 [0.46–0.73]) and Hispanic (0.69 [0.54–0.88]) patients were less likely to receive both chemotherapy and surgery. Being of black race was significantly correlated with worse overall survival [HR 1.13 (1.03–1.23); p = .02]. Conclusions. Non-white women are less likely to receive the standard of care treatment for ovarian cancer and more likely to die from their disease than white women.

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The Cost of Initial Care for Medicare Patients With Advanced Ovarian Cancer

Cited by 33 publications

References 26 publications

Cost of Care for the Initial Management of Ovarian Cancer

Cost of Care for the Initial Management of Ovarian Cancer

Guideline Discordance and Patient Cost Responsibility in Medicare Beneficiaries With Metastatic Breast Cancer

Disparities in treatment and survival among elderly ovarian cancer patients

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