What drives costs of prostate cancer care?

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An analysis of Medicare expenditures in the first year after a diagnosis of prostate cancer shows that 5% of patients account for almost 25% of the total spending.

Results of a population-based study analyzing Medicare expenditures in the first year after men are diagnosed with prostate cancer show that 5% of patients account for almost 25% of the total spending that year.

The variables found to contribute to being a high-resource patient include both clinical and non-clinical factors, reported first author Maxine Sun, PhD, MPH, at the AUA annual meeting in Chicago.

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“In terms of contribution to the burden of national health care expenditures, treatment of men with prostate cancer ranks among the top five cancers. Understanding of service utilization and the factors associated with high-resource spending for this patient population is important for identifying strategies for optimizing value-based care,” said Dr. Sun, of Brigham and Women’s Hospital and the Lank Center for Genitourinary Oncology at the Dana-Farber Cancer Institute, Boston.

The research, which was funded by an AUA Data Grant, analyzed payment data for a Surveillance, Epidemiology, and End Results Medicare prostate cancer population. It included 12,875 men ages ≥66 years who were diagnosed with prostate cancer in 2009 and had at least 1 year of continuous follow-up.

The cohort was divided into two groups according to spending status (top 5% vs. bottom 95% resource-patients). The 646 men comprising the top 5% of spenders accounted for almost $62.5 million of the total $241 million spent in 2009.

Next: The average cost for prostate cancer-related care was almost $10,000 greater for men in the top 5% of spenders than for those in the bottom 95%Analyses of inpatient costs showed that the average cost for prostate cancer-related care was almost $10,000 greater for men in the top 5% of spenders than for those in the bottom 95%: $22,284 versus $13,151. Average spending for non-prostate cancer inpatient care was almost $15,000 higher for men in the top 5% of spenders compared with those in the bottom 95%: $28,767 versus $13,908.

For outpatient services, the top 5% of spenders accrued $1,417 in expenditures for prostate cancer-related care and $1,011 for non-prostate cancer-related care; corresponding expenditures for the bottom 95% of spenders were $1,297 and $770, respectively.

A univariable analysis of potential patient, disease, sociodemographic, and regional characteristics associated with being a high-resource user showed that compared with the men in the bottom 95% of spenders, the top 5% group was comprised of men who were significantly older, sicker at diagnosis, more likely to be African-American, less likely to be married, and more likely to have advanced-stage or metastatic disease.

A multivariable analysis found that more advanced tumor stage, metastatic disease, unmarried status, higher Charlson Comorbidity Index, and living in a high Medicare spending health service area were all independently associated with being a top 5% spender.

“We hypothesized that the top 5% resource-patients are invariably sicker and older than the bottom 95% resource-patients. Strikingly, we found that approximately one-third of men in the group comprising the top 5% of spenders died in the year after their prostate cancer diagnosis compared with just 5% of their counterparts in the bottom 95% resource-patients,” Dr. Sun said.

“These results and our findings about higher prostate cancer-related spending suggest that providers may need to be more judicious with decisions about active treatment for cancer for sicker patients,” she added.

In contrast, finding that the top 5% resource-patients were more likely to live in a high Medicare spending health service area was not expected. Determination of the exact factors underlying this relationship is not possible given the information available within the database, Dr. Sun said.

“The finding, however, points to a need for further research to understand the responsible organizational factors,” she said.