The Cost to Medicare of Bladder Cancer Care

Abstract

Background: Bladder cancer care is costly, including cost to Medicare, but the medical cost associated with bladder cancer patients relative to identical persons without bladder cancer is unknown.

Objective: To determine incremental bladder cancer cost to Medicare and the impact of diagnosis stage and bladder cancer survival on cost.

Design, setting, and participants: A case-control study was conducted using 1998-2013 Surveillance, Epidemiology and End Results-Medicare data. Controls were propensity score matched for diagnosis year, age, gender, race, and 31 Elixhauser Comorbidity Index values. Three incident cohorts, 1998 (n=3136), 2003 (n=7000), and 2008 (n=7002), were compared.

Outcome measurements and statistical analysis: Survival following diagnosis and Medicare payments (in 2018 dollars) were tabulated, and compared between cases and controls.

Results and limitations: From 1998 to 2008, bladder cancer patients became older and had more comorbidities at diagnosis, although no stage migration or change in survival occurred. Incremental costs (above those associated with controls) were highest during the 1st year after diagnosis and were higher for distant ($47533) than for regional ($42403) or localized ($14304) cancer. Bladder cancer survival was highly stage dependent. After an initial spike in costs lasting 1-2yrs, monthly costs dropped in survivors but remained higher than for controls. Long-term survivors in the full sample accrued cumulative Medicare costs of $172426 over 16yrs-46% higher than for controls. Limitations include omission of indirect costs and reliance on traditional Medicare.

Conclusions: While a bladder cancer diagnosis incurs initial high Medicare cost, particularly in patients with advanced cancers, the cumulative costs of bladder cancer in long-term survivors are higher still. Bladder cancer prevention saves Medicare money. However, while early detection, better therapies, and life extension of bladder cancer patients are worthwhile goals, they come at the cost of higher Medicare outlays.

Patient summary: The lifetime cost of bladder cancer, reflecting surveillance, treatment, and management of complications, is substantial. Since care is ongoing, cost increases with the length of life after diagnosis as well as the severity of initial diagnosis.

Keywords: Bladder cancer; Cost analysis; Elderly; Health economics; Medicare.