Comparison of Approaches for Estimating Incidence Costs of Care for Colorectal Cancer Patients

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892, USA.
Medical care (Impact Factor: 3.23). 07/2009; 47(7 Suppl 1):S56-63. DOI: 10.1097/MLR.0b013e3181a4f482
Source: PubMed

ABSTRACT Estimates of the costs of medical care vary across patient populations, data sources, and methods. The objective of this study was to compare 3 approaches for estimating the incidence costs of colorectal cancer (CRC) care using similar patient populations, but different data sources and methods.
We used 2 data sources, linked SEER-Medicare and Medicare claims alone, to identify newly diagnosed CRC patients aged 65 and older and estimated their healthcare costs during the observation period, 1998 to 2002. Controls were matched by sex, age-group, and geographic location. We compared mean net costs, measured as the difference in total cost between cases and controls, for: (1) a SEER-Medicare cohort, (2) a Medicare claims alone cohort, and (3) a modeled phase of care approach using linked SEER-Medicare data. The SEER-Medicare cohort approach was considered the reference.
We found considerable variability across approaches for estimating net costs of care in CRC patients. In the first year after diagnosis, mean net costs were $32,648 (95% CI: $31,826 and $33,470) in the SEER-Medicare cohort. The other approaches understated mean net costs in year 1 by about 16%. Mean net 5-year costs of care were $37,227 (95% CI: $35,711 and $38,744) in the SEER-Medicare cohort, and $30,310 (95% CI: $25,894 and $34,726) in the claims only approach, with the largest difference in the 65 to 69 age group. Mean net 5-year costs of care were more similar to the reference in the modeled phase of care approach ($37,701 [range: $36,972 and $38,446]). Differences from the SEER-Medicare cohort estimates reflect misclassification of prevalent cancer patients as newly diagnosed patients in the Medicare claims only approach, and differences in years of data and assumptions about comparison groups in the modeled phase of care approach.
CRC incidence cost estimates vary substantially depending on the strategy and data source for identifying newly diagnosed cancer patients and methods for estimating longitudinal costs. Our findings may inform estimation of costs for other cancers as well as other diseases.

3 Reads
  • Source
    • "Five studies reported condition-specific expenditures [14,18,39– 41] (attribution approach), and two studies used disease-related events to identify patients [13] [31]. Three studies used just a matching approach [25] [34] [35], and five studies reported the summation of all medical expenditures associated with a condition approach [17] [20] [21] [23] [24]. There was considerable methodological heterogeneity among the regression models. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To inform policymakers of the importance of evaluating various methods for estimating the direct medical expenditures for a low-incidence condition, head and neck cancer (HNC). Four methods of estimation have been identified: 1) summing all health care expenditures, 2) estimating disease-specific expenditures consistent with an attribution approach, 3) estimating disease-specific expenditures by matching, and 4) estimating disease-specific expenditures by using a regression-based approach. A literature review of studies (2005-2012) that used the Medical Expenditure Panel Survey (MEPS) was undertaken to establish the most popular expenditure estimation methods. These methods were then applied to a sample of 120 respondents with HNC, derived from pooled data (2003-2008). The literature review shows that varying expenditure estimation methods have been used with MEPS but no study compared and contrasted all four methods. Our estimates are reflective of the national treated prevalence of HNC. The upper-bound estimate of annual direct medical expenditures of adult respondents with HNC between 2003 and 2008 was $3.18 billion (in 2008 dollars). Comparable estimates arising from methods focusing on disease-specific and incremental expenditures were all lower in magnitude. Attribution yielded annual expenditures of $1.41 billion, matching method of $1.56 billion, and regression method of $1.09 billion. This research demonstrates that variation exists across and within expenditure estimation methods applied to MEPS data. Despite concerns regarding aspects of reliability and consistency, reporting a combination of the four methods offers a degree of transparency and validity to estimating the likely range of annual direct medical expenditures of a condition.
    Value in Health 01/2014; 17(1):90-7. DOI:10.1016/j.jval.2013.10.004 · 3.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The author analyses the business model of Application Service Provider (ASP) as a less material intensive alternative to traditional computing-a promising example of ICT sector dematerialisation. The article compares the ASP vs. traditional computing models from environmental and business perspectives. The ASP service model has a potential to provide both economic and environmental benefits. By using the results from the available life cycle studies on personal computers the author conducts a rough analysis of the environmental gains from using the ASP model. The key environmental benefits derive from using a "lighter" hardware such as thin clients and the possibilities to extend its lifetime. The conclusions show that there are several groups of barriers: technical, cultural, knowledge, economic and legal barriers that can be addressed by different actors. Companies can overcome some of those barriers, but the issues of property and privacy right protection; anti-trust legislation, standardisation and infrastructure development have to be addressed by government. ASP stakeholders can find it interesting to identify and exploit the potential environmental benefits of ICT outsourcing
    Electronics and the Environment, 2002 IEEE International Symposium on; 02/2002
  • Source
    Medical care 07/2009; 47(7 Suppl 1):S120-6. DOI:10.1097/MLR.0b013e3181a9d366 · 3.23 Impact Factor
Show more


3 Reads
Available from