Costs and trends in pancreatic cancer treatment

Abstract

Background: Pancreatic cancer poses a substantial morbidity and mortality burden in the United States, and predominantly affects older adults. The objective of this study was to estimate the direct medical costs of pancreatic cancer treatment in a population-based cohort of Medicare beneficiaries, and the contribution of different treatment modalities and health care services to the total cost of care and trends in costs over time.

Methods: In the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, pancreatic cancer patients were identified who were aged 66 years or older and who were diagnosed from 2000 to 2007. Total direct medical costs were estimated from Medicare payments overall and within categories of care. Costs attributable to pancreatic cancer were estimated by subtracting the costs of medical care in a matched cohort of cancer-free beneficiaries.

Results: A total of 15,037 patients were identified, of whom 97% were observed from diagnosis until death. Mean total direct medical costs were $65,500. Mean total costs were greater for patients with resectable locoregional disease ($134,700) than for those with unresectable locoregional or distant disease ($65,300 and $49,000, respectively). Hospitalizations and cancer-directed procedures collectively accounted for the largest fraction of health care costs. The total cost of care appeared to increase slightly over the study period (P = .05). The mean costs attributable to pancreatic cancer were $61,700.

Conclusions: Despite poor prognosis and short survival, the economic burden of pancreatic cancer in the elderly is substantial. Demographic trends, greater use of targeted therapies, and possible implementation of screening strategies are likely to impact treatment patterns and costs in the future.

Figure 1

Overall survival is shown by stage at diagnosis.

Figure 2

Trends in mean total costs are shown by stage at diagnosis. Costs were estimated from Medicare reimbursement for all health services, adjusted for inflation and geographic variability. There appeared to be a marginal increase in mean total costs for the overall cohort between 2000 and 2007 (P = .05).

Figure 3

Trends in mean costs are shown by category. Costs were estimated from Medicare reimbursement for health services within each category, adjusted for inflation and geographic variability. “Other” costs increased between 2000 and 2007 (P < .001). Procedure costs decreased (P < .001). Chemo indicates chemotherapy; RT, radiation therapy.

Figure 4

Mean total and incremental costs are shown by stage at diagnosis. Costs were estimated from Medicare reimbursement for health services within each category, adjusted for inflation and geographic variability. Non-cancer costs were estimated from cancer-free Medicare beneficiaries matched 1:1 by sex, race, year of birth, and Surveillance, Epidemiology, and End Results (SEER) registry to each pancreatic cancer case. The mean monthly costs of medical care for each cancer-free beneficiary was based on the 12 months of claims in the year of diagnosis of their matched case. This average monthly cost was then multiplied by the number of months the matched case was alive. Cancer-attributable costs were the total costs in pancreatic cancer cases minus total costs in the matched cancer-free cohort over the same survival duration.