Costs associated with 5 years of care for newly diagnosed Medicare patients
Posted Aug 23 2010 12:00am
According to a media release from the American Cancer Society, a paper newly published online in Cancer suggests that some treatments for prostate cancer that are relatively low cost in the short term (i.e., in the first 12 months after treatment) may have higher costs over 5 years.
The abstract of the new paper by Snyder et al. is not yet available on line on either the PubMed web site or on the Cancer journal web site, so at present we are entirely dependent on the data in the American Cancer Society’s media release .
Snyder et al. are said to have used data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database to assess costs associated with treatment of 13,769 men aged 66 or older who received treatment for early stage prostate cancer in 2000 and who were then followed for up to 5 years. The patients were classified based on the treatment they received during the initial 9 months after diagnosis (watchful waiting, radiation, hormonal therapy, hormonal therapy + radiation, and surgery). Patients receiving surgical treatment as their primary therapy may also have received radiation and/or hormone therapy in that 9-month period, depending on the initial outcome after surgery.
Treatment costs were assessed according to time periods: the initial costs (months -1 to 12), the long-term costs (each 12 months thereafter), and the total costs (months -1 to 60). The incremental costs of care were calculated as the difference in medical costs for these prostate cancer patients versus a group of similar men without cancer.
The investigators found the following results:
For most prostate cancer cases, costs were highest in the initial year; they then dropped sharply and remained steady over the next several years.
Cost patterns varied widely in the short-term and long-term based on initial treatment received.
Watchful waiting was associated with the lowest initial costs ($4,270) and total costs ($9,130).
Initial treatment costs were highest for patients who received hormonal therapy + radiation ($17,474), followed by those undergoing surgery ($15,197).
Hormonal therapy had the second lowest initial costs but the highest total costs ($26,896).
Hormonal therapy + radiation ($25,097) and surgery ($19,214) had the second and third highest total costs.
After excluding the last 12 months of life (because patterns of costs are quite different in the period prior to death), total costs were highest for hormonal therapy + radiation ($23,488) and hormonal therapy only ($23,199).
While these data do indeed “provide new information for patients, providers, and payers involved in prostate cancer care” (as stated ion the media release), it is hard to know just how meaningful or helpful they really are. There are good reasons why carefully selected patients should and do have hormone therapy or radiation + hormone therapy as opposed to expectant management or surgery. And if these patients are the ones being diagnosed with more advanced forms of disease, it is hardly surprising that it would prove more costly to treat them over a 5-year time frame. There are also many patients who are probably over-treated or treated unnecessarily when they could simply have been monitored.
And then one has to consider (a) whether these data, based on patients diagnosed in 2000, are entirely relevant for patients being diagnosed today a decade later; (b) whether a 5-year follow-up is appropriate for a disease that is commonly associated with 15 or more years of survival post-diagnosis; and (c) whether a lower age limit of 66 is sufficiently inclusive of the costs of treatment for the many men now being diagnosed in their 50s and early 60s as opposed to their mid-60s and older.
We suggest you make of this what you will. We have doubts about drawing any significant conclusions from this paper.
According to a media release from the American Cancer Society, a paper newly published online in Cancer suggests that some treatments for prostate cancer that are relatively low cost in the short term (i.e., in the first 12 months after treatment) may have higher costs over 5 years.
The abstract of the new paper by Snyder et al. is not yet available on line on either the PubMed web site or on the Cancer journal web site, so at present we are entirely dependent on the data in the American Cancer Society’s media release .
Snyder et al. are said to have used data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database to assess costs associated with treatment of 13,769 men aged 66 or older who received treatment for early stage prostate cancer in 2000 and who were then followed for up to 5 years. The patients were classified based on the treatment they received during the initial 9 months after diagnosis (watchful waiting, radiation, hormonal therapy, hormonal therapy + radiation, and surgery). Patients receiving surgical treatment as their primary therapy may also have received radiation and/or hormone therapy in that 9-month period, depending on the initial outcome after surgery.
Treatment costs were assessed according to time periods: the initial costs (months -1 to 12), the long-term costs (each 12 months thereafter), and the total costs (months -1 to 60). The incremental costs of care were calculated as the difference in medical costs for these prostate cancer patients versus a group of similar men without cancer.
The investigators found the following results:
While these data do indeed “provide new information for patients, providers, and payers involved in prostate cancer care” (as stated ion the media release), it is hard to know just how meaningful or helpful they really are. There are good reasons why carefully selected patients should and do have hormone therapy or radiation + hormone therapy as opposed to expectant management or surgery. And if these patients are the ones being diagnosed with more advanced forms of disease, it is hardly surprising that it would prove more costly to treat them over a 5-year time frame. There are also many patients who are probably over-treated or treated unnecessarily when they could simply have been monitored.
And then one has to consider (a) whether these data, based on patients diagnosed in 2000, are entirely relevant for patients being diagnosed today a decade later; (b) whether a 5-year follow-up is appropriate for a disease that is commonly associated with 15 or more years of survival post-diagnosis; and (c) whether a lower age limit of 66 is sufficiently inclusive of the costs of treatment for the many men now being diagnosed in their 50s and early 60s as opposed to their mid-60s and older.
We suggest you make of this what you will. We have doubts about drawing any significant conclusions from this paper.