Improvements in breast cancer survival and increasing population life expectancy have resulted in a growing number of women receiving subsequent health care after breast cancer diagnosis and treatment. We sought to determine the magnitude of increases in healthcare costs related to breast cancer survivorship, in anticipation of predicted increases in enrollment, higher intensity utilization, and greater healthcare spending among Medicare beneficiaries.
Women age 65+ diagnosed with stage 0-III breast cancer in 1998, 2003 or 2008, were identified from the SEER database linked to Medicare records. After restrictions they were propensity score matched to a comparable group of non-breast-cancer women on demographic characteristics and co-morbidities at time of diagnosis based on the Elixhauser co-morbidity index. Line payments to care providers were then calculated for the first year of care after diagnosis (cases only) as well as years 2-6, 8-11 and 12-16 post-diagnosis (cases and controls). Direct Medicare costs were adjusted for inflation using the experimental Medicare costs Price Index and compared under real world and alternative survival scenarios.
Overall, the costs of care were progressively higher in later cohorts across all time periods. Differences in survivorship were the primary driver of differences in costs between breast cancer cases and controls. All-stage costs in years 2-6 were higher in the cancer group ($2,499, $10,261 and $12,029 higher per-person in 1998, 2003 and 2008 respectively), however, higher mortality in the cancer group reduced the costs and quantity of care received in later years [years 7-11 ($2,183 lower per-person in 1998) and 12-16 ($2,431 lower per-person in 1998)]. In pairs with identical survival, costs in the cancer group were significantly higher than in matched non-breast-cancer controls across all time periods (years 2-6: $4,799, $9,545 and $12,245 higher in 1998/2003/2008; years 7-11: $2,922 and $5,597 higher in 1998/2003). Stratification by stage changed the magnitude but not the general pattern of our results. The first year of care in 2003 was on average $4,933 dollars higher than in 1998; in 2008 costs again increased by $4,223 per-person. In years 2-6 the cost of cancer care increased by $12,440 (2003 vs 1998) and $3,456 (2008 vs 2003) per-person; Finally, cancer care for years 7-11 in 2003 $3,964 higher than in 1998 per-person.
Improved breast cancer survival and increased overall life expectancy among women in the United States will contribute to higher Medicare expenditures. Future risk-based capitation schemes should account for these advancements when preparing for healthcare delivery after cancer.
Citation Format: Greenup RA, Yashkin A, Gorbunova G, Akusevich I, Hwang ES. Medicare costs for women after breast cancer: Preparing for survivorship [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-08.