Lisa M. Lines

Lifetime and Treatment-Phase Costs Associated With Colorectal Cancer: Evidence from SEER-Medicare Data

BACKGROUND & AIMS This study provides detailed estimates of lifetime and phase-specific colorectal cancer (CRC) treatment costs. METHODS This retrospective cohort study included patients aged 66 years and older, newly diagnosed with CRC in a Surveillance Epidemiology and End Results (SEER) registry (1996-2002), matched 1:1 (by age, sex, and geographic region) to patients without cancer from a 5% sample of Medicare beneficiaries. The Kaplan-Meier sample average estimator was used to estimate observed 10-year costs, which then were extrapolated to 25 years. A secondary analysis computed costs on a per-survival-year basis to adjust for differences in mortality by stage and age. Costs were expressed in 2006 US

Factors associated with improved survival among older colorectal cancer patients in the US: a population-based analysis

, with future costs discounted 3% per year. RESULTS Our sample included 56,838 CRC patients (41,256 colon cancer [CC] patients and 15,582 rectal cancer [RC] patients; mean +/- SD age, 77.7 +/- 7.1 y; 55% women; and 86% white). Lifetime excess costs were

A review of the costs and cost effectiveness of interventions in chronic kidney disease: implications for policy.

29,500 for CC and

Patient-centered, Person-centered, and Person-directed Care They are Not the Same

26,500 for RC patients. Per survival year, stage IV CRC patients incurred

Estimating the short-term clinical and economic benefits of smoking cessation: do we have it right?

31,000 in excess costs compared with

Trends in healthcare utilization among older Americans with colorectal cancer: A retrospective database analysis

3000 for stage 0 patients. CRC patients incurred excess costs of

A Health-economic Assessment of Cervical Disc Arthroplasty Compared With Allograft Fusion

33,500 in the initial phase,

Qualitative analysis and conceptual mapping of patient experiences in home health care

4500/y in the continuing phase, and

Patient experience and process measures of quality of care at home health agencies: Factors associated with high performance

14,500 in the terminal phase. RC patients had lower costs than CC patients in the initial phase, but higher costs in both the continuing and terminal phases. CONCLUSIONS Excess costs associated with CRC are striking and vary considerably by treatment phase, cancer subsite, and stage at diagnosis. Interventions aimed at earlier diagnosis and prevention have the potential to reduce cancer-related health care costs.

Cancer registry-survey data linkages to measure patient-centered quality of care: SEER-MHOS and SEER-CAHPS.

BackgroundThe purpose of this study was to estimate the relative impact of changes in demographics, stage at detection, treatment mix, and medical technology on 5-year survival among older colorectal cancer (CRC) patients.MethodsWe selected older patients diagnosed with CRC between 1992 and 2000 from the SEER-Medicare database and followed them through 2005. Trends in demographic characteristics, stage at detection and initial treatment mix were evaluated descriptively. Separate multivariate logistic regression models for colon (CC) and rectal cancer (RC) patients were estimated to isolate the independent effects of these factors along with technological change (proxied by cohort year) on 5-year survival.ResultsOur sample included 37,808 CC and 13,619 RC patients (combined mean ± SD age: 77.2 ± 7.0 years; 55% female; 87% white). In recent years, more CC patients were diagnosed at Stage I and fewer at Stages II and IV, and more RC patients were diagnosed at Stage I and fewer at Stages II and III. CC and RC patients diagnosed in later years were slightly older with somewhat better Charlson scores and were more likely to be female, from the Northeast, and from areas with higher average education levels. Surgery alone was more common in later years for CC patients while combined surgery, chemotherapy, and radiotherapy was more common for RC patients. Between 1992 and 2000, 5-year observed survival improved from 43.0% to 46.3% for CC patients and from 39.4% to 42.2% for RC patients. Multivariate logistic regressions indicate that patients diagnosed in 2000 had significantly greater odds of 5-year survival than those diagnosed in 1992 (OR: 1.35 for CC, 1.38 for RC). Our decomposition suggests that early detection had little impact on survival; rather, technological improvements (e.g., new medical technologies or more effective use of existing technologies) and changing demographics were responsible for the largest share of the change in 5-year survival in CC and RC between 1992 and 2000.ConclusionTechnological advances and changes in patient demographics had the largest impact on improved colorectal cancer survival during the study period.