Costs for treating Medicare patients with cancer increased substantially from 1991 to 2002, researchers report.
Link: Medicare Costs for Cancer Treatment Soar
The upward trend, seen with breast, lung and colorectal cancer in particular, reflects the fact that more patients are receiving radiation and chemotherapy, and those treatments are costing more. This may also influence what treatments doctors decide to use, one expert says.
"The U.S. population is getting older, and it's growing, so there will be more people with cancer, so the burden to the Medicare program is likely to increase," said study co-author Robin Yabroff, an epidemiologist at the U.S. National Cancer Institute.
These costs are also increasing, because the Medicare program has expanded and includes more prescription drugs, Yabroff explained, noting that many of these newer drugs were not included in the current study.
"The cost of these new agents is going to have substantial impact on Medicare," Yabroff said. "The costs of cancer care are increasing, and there are changes in the types of care cancer patients are receiving. More breast, lung and colorectal cancer patients are receiving chemotherapy."
There are also changes in cancer surgery and radiation therapy, which may add to the Medicare bill, Yabroff noted.
The study is in the June 10 online edition of the Journal of the National Cancer Institute.
In the study, Yabroff's team collected data on 306,709 men and women aged 65 and older diagnosed with breast, lung, colorectal or prostate cancer between 1991 and 2002. These data were taken from the Surveillance, Epidemiology, and End-Results (SEER) Medicare database.
The researchers compared costs of initial cancer treatments including surgery, chemotherapy, radiation therapy and other hospitalization. In 2002, the total cost in the United States for initial cancer care was $6.7 billion.
Over the course of the study, the average cost for treating a lung cancer patient went up $7,139, to an average of $39,891. With prostate cancer, the average price tag for treatment went up $5,345, to an average of $41,134. The cost of treating breast cancer went up $4,189, to an average cost of $20,964.
However, the cost of treating prostate cancer dropped $196, to an average of $18,261 in 2002. The drop in cost was due to fewer men undergoing surgery for their cancer, the researchers found.
From 1991 to 2002, the number of patients receiving chemotherapy for lung, colorectal and breast cancer rose. The increase in chemotherapy, along with the higher costs of new drugs, accounted for much of the increased costs, Yabroff said. However, hospital costs still made up the largest percentage of the increased costs.
Yabroff noted that these costs do not include many of the newest, and most expensive, drugs in use.
The researchers believe that these expensive chemotherapy drugs will place a strain on Medicare. Therefore, Medicare needs to plan how to pay for new treatments and may have to find ways to identify those patients who will benefit the most from these expensive treatments and restrict their use to those patients.
One expert says that increasing costs for cancer treatment are having a significant effect on Medicare's ability to provide them and a patient's ability to pay for them.
"There were changes to Medicare payment policy over the period of this study. And they had significant impact on how physicians were reimbursed," said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society. "The net result is that it may have influenced practice patterns that we are seeing, such as the transition from surgery and radiation therapy for prostate cancer."
Lichtenfeld noted that many new drugs have driven the costs up even further. "The impact to Medicare is going to be substantial," he said.
Moreover, increasing costs may actually be preventing some Medicare patients from getting cancer treatment they need, Lichtenfeld said.
"In February, Avastin was approved for the treatment of recurrent breast cancer. It costs about $55,000 a year for a Medicare patient to receive the drug," Lichtenfeld said. "But there is a 20 percent co-pay. If a Medicare patient has insurance, it may be covered, but if they don't have insurance, there is an $11,000 co-pay to cover -- and $11,000 is a lot of money."
There is anecdotal evidence that doctors and patients are being forced to consider costs when they make choices for treatment regimens, Lichtenfeld said.
"Some people are not able to afford those treatments," he said. "The increased use of expensive chemotherapy is having an impact on how we treat cancer patients."
Source: HealthDay
The shift in the United States, more than 20 years ago, from the institution-based, inpatient setting to community-based, ambulatory sites for treating the majority of the nation's cancer patients has prompted in large part additional costs to the government and Medicare beneficiaries.
More and more emerging data is showing that there is a continuing problem with the Chemotherapy Concession. A system which rewards medical oncologists for being pharmacists. The Chemotherapy Concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement.
Cancer sufferers are taking doses of expensive and toxic treatments that are possibly well in excess of what they need. Pharmaceutical companies are attracted to studies that look at the maximum tolerated dose of any treatments. Evidence has shown that many of the highly expensive targeted cancer drugs may be just as effective and produce fewer side effects if taken over shorter periods and in lower doses.
Although the new Medicare bill tried to curtail the Chemotherapy Concession, private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and force them be doctors again.
http://www.healthyskepticism.org/news/2007/Jun.php
Posted by: Gregory D. Pawelski | July 06, 2008 at 05:18 PM