Medical Care Burden of Cancer: System and Data Issues

Most cancer cost estimates are from the NCI's SEER cancer registries linked to Medicare claims (SEER-Medicare). These data only represent the experience of the more than 80% of aged Medicare beneficiaries enrolled in the fee-for-service (FFS) indemnity option; no information is available about the remaining seniors enrolled in Medicare HMOs. In addition to differences in patient benefits, HMO providers face different incentives, and because beneficiaries select their coverage, the populations may differ in their health status and preferences in ways that are difficult to measure. These factors may cause selection and omission biases in cancer cost estimates based on either group alone.

This project, led by Dr. Mark Hornbrook (KPNW), will extend and complement the SEER-Medicare link by (1) estimating the incremental medical care cost of all cancers by cancer site, stage at diagnosis, patient demographics, and source of health insurance (FFS vs. HMO); (2) estimating costs of non-Medicare covered services; and (3) modeling the determinants of cancer costs across HMO and FFS systems, correcting for selection and omissions biases. The study team received an NCI supplement to estimate the costs of cancer care in the non-elderly population. Additionally, Dr. Hornbrook is leading the study team with a pilot study to estimate the cancer-related pharmacy costs among aged Medicare HMO beneficiaries that are not covered in FFS Medicare. A byproduct of this body of research will be the development of a reusable infrastructure that will enhance the CRN VDW for other uses, including efforts focused on the dissemination of pharmacotherapy among cancer patients over time.

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