Dataset Information

The Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer.

ABSTRACT:

Objective

To characterize Medicare expenditures on initial breast cancer care and examine variation in expenditures across hospital referral regions (HRRs).

Data source

We identified 29,110 women with localized breast cancer diagnosed in 2005-2008 and matched controls from the Surveillance, Epidemiology, and End Results-Medicare linked database.

Study design

Using hierarchical generalized linear models, we estimated per patient Medicare expenditure on initial breast cancer care across HRRs and assessed the contribution of patient, cancer, and treatment factors to regional variation via incremental models.

Principal findings

Mean Medicare expenditure for initial breast cancer care was $19,255 per patient. The average expenditures varied from $15,053 in the lowest-spending HRR quintile to $23,480 in the highest-spending HRR quintile. Patient sociodemographic, comorbidity, and tumor characteristics explained only 1.8 percent of the difference in expenditures between the lowest- and highest-spending quintiles, while use of specific treatment modalities explained 14.5 percent of the difference. Medicare spending on radiation therapy differed the most across the quintiles, with the use of intensity modulated radiation therapy increasing from 1.7 percent in the lowest-spending quintile to 11.6 percent in the highest-spending quintile.

Conclusions

Medicare expenditures on initial breast cancer care vary substantially across regions. Treatment factors are major contributors to the variation.

SUBMITTER: Xu X

PROVIDER: S-EPMC4722219 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer.

Xu Xiao X Herrin Jeph J Soulos Pamela R PR Saraf Avantika A Roberts Kenneth B KB Killelea Brigid K BK Wang Shi-Yi SY Long Jessica B JB Wang Rong R Ma Xiaomei X Gross Cary P CP

Health services research 20150629 1

<h4>Objective</h4>To characterize Medicare expenditures on initial breast cancer care and examine variation in expenditures across hospital referral regions (HRRs).<h4>Data source</h4>We identified 29,110 women with localized breast cancer diagnosed in 2005-2008 and matched controls from the Surveillance, Epidemiology, and End Results-Medicare linked database.<h4>Study design</h4>Using hierarchical generalized linear models, we estimated per patient Medicare expenditure on initial breast cancer ...[more]

PMID: 26119176

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Project description:IntroductionWe aimed to determine if racial/ethnic disparities exist in survivorship care patient experiences among older breast cancer survivors.Materials and methodsNineteen thousand seventeen female breast cancer survivors aged ≥65 at post-diagnosis survey contributed data via the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) and Centers for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers & Systems (CAHPS) data linkage (2000-2019). Multivariable linear regression models were used to estimate adjusted beta (β) coefficients and standard error (SE) estimates for associations between race/ethnicity and survivorship care patient experiences.ResultsMost women were non-Hispanic (NH)-White (78.1%; NH-Black [8.1%], NH-Asian [6.5%], Hispanic [6.2%]). On average, women reported 76.3 years (standard deviation [SD] = 7.14) at CAHPS survey and 6.10 years since primary diagnosis (SD = 3.51). Compared with NH-White survivors, NH-Black survivors reported lower mean scores for Getting Care Quickly (β = -5.17, SE = 0.69, p ≤0.001), Getting Needed Care (β = -1.72, SE = 0.63, p = 0.006), and Overall Care Ratings (β = -2.72, SE = 0.48, p ≤0.001), mirroring the results for NH-Asian survivors (Getting Care Quickly [β = -7.06, SE = 0.77, p ≤0.001], Getting Needed Care [β = -4.43, SE = 0.70, p ≤0.001], Physician Communication [β = -1.15, SE = 0.54, p = 0.03], Overall Care Rating [β = -2.32, SE = 0.53, p ≤0.001]). Findings among Hispanic survivors varied, where mean scores were lower for Getting Care Quickly (β = -2.83, SE = 0.79, p ≤0.001), Getting Needed Care (β = -2.43, SE = 0.70, p = 0.001), and Getting Needed Prescription Drug(s) (β = -1.47, SE = 0.64, p = 0.02), but were higher for Health Plan Rating (β = 2.66, SE = 0.55, p ≤0.001). Education, Medicare plan, and multimorbidity significantly modified various associations among NH-Black survivors, and education was a significant modifier among NH-Asian and Hispanic survivors.DiscussionWe observed racial/ethnic disparities in the associations with survivorship care patient experience among NH-Black, Hispanic, and NH-Asian breast cancer survivors. Future research should examine the impact of education, Medicare plans, and multimorbidity on these associations.

Project description:ImportanceConsiderable efforts have been dedicated to improving the quality of end-of-life care among patients with advanced cancer in the past decade. Whether the quality has shifted in response to these efforts remains unknown.ObjectiveTo examine contemporary patterns of end-of-life care among patients with advanced cancer.Design, setting, and participantsThis retrospective cohort study used a recent linkage of Surveillance, Epidemiology, and End Results and Medicare data to characterize patterns of end-of-life care. The cohort included fee-for-service Medicare decedents aged 66 years or older who were originally diagnosed with distant-stage breast, prostate, pancreatic, or lung cancers and died between 2014 and 2019. Analyses were conducted between June 1, 2023, and July 31, 2024.Main outcomes and measuresOutcomes included monthly use of acute care, systemic therapy, and supportive care (ie, palliative and hospice care and advanced care planning) in the last 6 months of life. Additionally, a claims-based indicator was evaluated of potentially aggressive care in the last 30 days of life, defined as experiencing more than 1 acute care visit, in-hospital mortality, late receipt of systemic therapy, or hospice entry.ResultsThe study included 33 744 Medicare decedents with advanced cancer (mean [SD] age, 75.7 [6.9] years; 52.1% male). From 6 months before death to month of death, there was an increase in the mean (SE) number of acute care visits (from 14.0 [0.5] to 46.2 [0.5] per 100 person-months), hospice use (from 6.6 [0.4] to 73.5 [0.5] per 100 person-months), palliative care (from 2.6 [0.2] to 26.1 [0.6] per 100 person-months), and advanced care planning (from 1.7 [0.6] to 12.8 [1.1] per 100 person-months). Overall, 45.0% of decedents experienced any indicator of potentially aggressive care.Conclusions and relevanceThis study found persistent patterns of potentially aggressive care, but low uptake of supportive care, among Medicare decedents with advanced cancer. A multifaceted approach targeting patient-, physician-, and system-level factors associated with potentially aggressive care is imperative for improving quality of care at the end of life.

Dataset Information

The Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer.

Objective

Data source

Study design

Principal findings

Conclusions

Publications

The Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer.

Similar Datasets

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