Costs of care associated with non-small-cell lung cancer in a commercially insured cohort

Bruce E. Hillner, M. Kathleen McDonald, Christopher E. Desch, Thomas J Smith, Lynne T. Penberthy, Patricia Maddox, Sheldon M. Retchin

Research output: Contribution to journalArticle

Abstract

Purpose: To examine the cost of incident cases of non-small-cell lung cancer (NSCLC) in a commercially insured cohort. Methods: Claims from Virginia Blue Cross and Blue Shield (BCB5) beneficiaries with lung cancer from 1989 to 1991 were merged with records from the Virginia Cancer Registry (VCR). Data from the VCR identified incident cases, stage, and type of cancer at diagnosis. Costs for all medical care included insurance payment, copayments, and deductibles for 2 years after diagnosis or until death. Results: Three hundred forty-nine incident NSCLC patients were evaluated. The mean 2-year cost for each patient after diagnosis or until death was $47,941 (95% confidence interval, $43,758 to $52,124). Total average costs and hospital days were significantly lower for local disease ($37,514, 21.2 days), but were similar for regional ($52,797, 30.0 days) and distant ($49,382, 33.0 days) disease. Hospital days accounted for 48% and hospital- based claims for 70% of costs. Initial treatments, which included radiation, unadjusted for stage, had the lowest survival rates and the highest costs, and were associated with the most hospital days. Initial stage, race, gender, and age were not predictors of total 2-year costs. The independent predictors of total 2-year costs were type of treatment: any radiation therapy, any surgery, or any chemotherapy (all, P <.001). Inpatient hospital days was only a modest predictor of costs after adjusting for type of treatment. Patients who survived less than 1 year spent 30.5 days in hospital and had an average cost of $47,280. Conclusion: The direct health care costs of younger NSCLC patients care are substantial. These results should serve as a benchmark for future comparisons as the United States market shifts to managed care.

Original languageEnglish (US)
Pages (from-to)1420-1424
Number of pages5
JournalJournal of Clinical Oncology
Volume16
Issue number4
StatePublished - Apr 1998
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Costs and Cost Analysis
Blue Cross Blue Shield Insurance Plans
Health Care Costs
Registries
Deductibles and Coinsurance
Benchmarking
Neoplasms
Hospital Costs
Managed Care Programs
Insurance
Inpatients
Lung Neoplasms
Patient Care
Radiotherapy
Survival Rate
Confidence Intervals
Radiation
Drug Therapy
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Hillner, B. E., McDonald, M. K., Desch, C. E., Smith, T. J., Penberthy, L. T., Maddox, P., & Retchin, S. M. (1998). Costs of care associated with non-small-cell lung cancer in a commercially insured cohort. Journal of Clinical Oncology, 16(4), 1420-1424.

Costs of care associated with non-small-cell lung cancer in a commercially insured cohort. / Hillner, Bruce E.; McDonald, M. Kathleen; Desch, Christopher E.; Smith, Thomas J; Penberthy, Lynne T.; Maddox, Patricia; Retchin, Sheldon M.

In: Journal of Clinical Oncology, Vol. 16, No. 4, 04.1998, p. 1420-1424.

Research output: Contribution to journalArticle

Hillner, BE, McDonald, MK, Desch, CE, Smith, TJ, Penberthy, LT, Maddox, P & Retchin, SM 1998, 'Costs of care associated with non-small-cell lung cancer in a commercially insured cohort', Journal of Clinical Oncology, vol. 16, no. 4, pp. 1420-1424.
Hillner BE, McDonald MK, Desch CE, Smith TJ, Penberthy LT, Maddox P et al. Costs of care associated with non-small-cell lung cancer in a commercially insured cohort. Journal of Clinical Oncology. 1998 Apr;16(4):1420-1424.
Hillner, Bruce E. ; McDonald, M. Kathleen ; Desch, Christopher E. ; Smith, Thomas J ; Penberthy, Lynne T. ; Maddox, Patricia ; Retchin, Sheldon M. / Costs of care associated with non-small-cell lung cancer in a commercially insured cohort. In: Journal of Clinical Oncology. 1998 ; Vol. 16, No. 4. pp. 1420-1424.
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abstract = "Purpose: To examine the cost of incident cases of non-small-cell lung cancer (NSCLC) in a commercially insured cohort. Methods: Claims from Virginia Blue Cross and Blue Shield (BCB5) beneficiaries with lung cancer from 1989 to 1991 were merged with records from the Virginia Cancer Registry (VCR). Data from the VCR identified incident cases, stage, and type of cancer at diagnosis. Costs for all medical care included insurance payment, copayments, and deductibles for 2 years after diagnosis or until death. Results: Three hundred forty-nine incident NSCLC patients were evaluated. The mean 2-year cost for each patient after diagnosis or until death was $47,941 (95{\%} confidence interval, $43,758 to $52,124). Total average costs and hospital days were significantly lower for local disease ($37,514, 21.2 days), but were similar for regional ($52,797, 30.0 days) and distant ($49,382, 33.0 days) disease. Hospital days accounted for 48{\%} and hospital- based claims for 70{\%} of costs. Initial treatments, which included radiation, unadjusted for stage, had the lowest survival rates and the highest costs, and were associated with the most hospital days. Initial stage, race, gender, and age were not predictors of total 2-year costs. The independent predictors of total 2-year costs were type of treatment: any radiation therapy, any surgery, or any chemotherapy (all, P <.001). Inpatient hospital days was only a modest predictor of costs after adjusting for type of treatment. Patients who survived less than 1 year spent 30.5 days in hospital and had an average cost of $47,280. Conclusion: The direct health care costs of younger NSCLC patients care are substantial. These results should serve as a benchmark for future comparisons as the United States market shifts to managed care.",
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