Medicare Spending for Breast, Prostate, Lung, and Colorectal Cancer Patients in the Year of Diagnosis and Year of Death

Abstract

Objective: To characterize spending patterns for Medicare patients with incident breast, prostate, lung, and colorectal cancer.

Data sources/study setting/study design: 2007-2012 data from the Surveillance, Epidemiology, and End Results Program linked with Medicare fee-for-service claims.

Data collection/extraction methods: We calculate per-patient monthly and yearly mean and median expenditures, by cancer type, stage at diagnosis, and spending category, over the years of diagnosis and death.

Principal findings: Over the year of diagnosis, mean spending was $35,849, $26,295, $55,597, and $63,063 for breast, prostate, lung, and colorectal cancer, respectively. Over the year of death, spending was similar across different cancer types and stage at diagnosis.

Conclusions: Characterization of Medicare spending according to clinically meaningful categories may assist development of oncology alternative payment models and cost-effectiveness models.

Keywords: Medicare; Oncology; alternative payment model.

© Health Research and Educational Trust.

Figures

Figure 1

Mean and Median Annual Per‐Patient Medicare Spending for Breast, Prostate, Lung, and Colorectal Cancer in the Year of Diagnosis and in the Year of Death [Color figure can be viewed at http://wileyonlinelibrary.com] Note: (A) The height of the columns represents mean spending. The orange diamond represents the median spending, with the corresponding orange whiskers representing the 25th to 75th interquartile range (IQR). Mean spending in the year of diagnosis included the 12 months beginning with the month of diagnosis, regardless of the month of death (patients contribute $0 after death). Mean spending in the year of death included the 11 months prior to death and the month of death, regardless of the timing of the cancer diagnosis. (B) Mean and median annual per‐patient Medicare spending for breast, prostate, lung, and colorectal cancer in the year of diagnosis and in the year of death, stratified by stage at diagnosis.

Figure 2

Mean Monthly Per‐Patient Medicare Spending for Breast, Prostate, Lung, and Colorectal Cancer, Extending from the Month Prior to Diagnosis (month −1) Through the 11th Month After Diagnosis (month 11), by Stage at Diagnosis (I, II, III, or IV) [Color figure can be viewed at http://wileyonlinelibrary.com] Note: Month 0 represents the month of diagnosis. Patients were included in monthly spending calculations up to the month of death and then subsequently censored from calculations. These monthly figures include a 13‐month period (rather than the 12‐month period for annual spending) to better reflect spending trends.

Figure 3

Mean Monthly Per‐Patient Medicare Spending for Breast, Prostate, Lung, and Colorectal Cancer Extending from the 11th Month Prior to Death (month 11) Through the Month of Death (month 0), by Stage at Diagnosis (I, II, III, or IV) [Color figure can be viewed at http://wileyonlinelibrary.com] Note: Patients were included in the monthly spending calculations only if they had been diagnosed with cancer.

Figure 4

Mean Annual Per‐Patient Medicare Spending for Breast, Prostate, Lung, and Colorectal Cancer in the Year of Diagnosis and Year of Death, by Category of Spending [Color figure can be viewed at http://wileyonlinelibrary.com] Note: Mean spending in the year of diagnosis included the 12 months beginning with the month of diagnosis, regardless of the month of death (patients contribute $0 after death). Mean spending in the year of death included the 11 months prior to death and the month of death, regardless of when the patient was diagnosed. Categories of spending were defined by Medicare claims. Inpatient and outpatient spending included drug spending billed under Part A and Part B, respectively. Prescription drug spending refers to spending under Medicare Part D.