Healthcare utilization and costs during the initial phase of care among elderly women with breast cancer

Ami Vyas, S. Suresh Madhavan, Usha Sambamoorthi, Xiaoyun Pan, Michael Regier, Hannah Hazard, Sita Kalidindi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service benefiiciaries diagnosed with BC, and to determine the factors associated with higher costs. Methods: A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003-2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. Results: A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66-69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. Conclusions: The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.

Original languageEnglish
Pages (from-to)1401-1409
Number of pages9
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume15
Issue number11
DOIs
StatePublished - 1 Nov 2017

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Health Care Costs
Breast Neoplasms
Costs and Cost Analysis
Medicare
Ambulatory Care
Delivery of Health Care
Linear Models
Physicians
Fee-for-Service Plans
Resource Allocation
Primary Care Physicians
Causality
African Americans
Observational Studies
Comorbidity
Radiotherapy
Retrospective Studies
Economics
Databases
Drug Therapy

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Vyas, Ami ; Madhavan, S. Suresh ; Sambamoorthi, Usha ; Pan, Xiaoyun ; Regier, Michael ; Hazard, Hannah ; Kalidindi, Sita. / Healthcare utilization and costs during the initial phase of care among elderly women with breast cancer. In: JNCCN Journal of the National Comprehensive Cancer Network. 2017 ; Vol. 15, No. 11. pp. 1401-1409.
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Healthcare utilization and costs during the initial phase of care among elderly women with breast cancer. / Vyas, Ami; Madhavan, S. Suresh; Sambamoorthi, Usha; Pan, Xiaoyun; Regier, Michael; Hazard, Hannah; Kalidindi, Sita.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 15, No. 11, 01.11.2017, p. 1401-1409.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Healthcare utilization and costs during the initial phase of care among elderly women with breast cancer

AU - Vyas, Ami

AU - Madhavan, S. Suresh

AU - Sambamoorthi, Usha

AU - Pan, Xiaoyun

AU - Regier, Michael

AU - Hazard, Hannah

AU - Kalidindi, Sita

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background: Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service benefiiciaries diagnosed with BC, and to determine the factors associated with higher costs. Methods: A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003-2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. Results: A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66-69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. Conclusions: The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.

AB - Background: Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service benefiiciaries diagnosed with BC, and to determine the factors associated with higher costs. Methods: A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003-2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. Results: A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66-69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. Conclusions: The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.

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DO - 10.6004/jnccn.2017.0167

M3 - Article

C2 - 29118232

AN - SCOPUS:85033802388

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SP - 1401

EP - 1409

JO - JNCCN Journal of the National Comprehensive Cancer Network

JF - JNCCN Journal of the National Comprehensive Cancer Network

SN - 1540-1405

IS - 11

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