A new type of study into the cost of patients’ time associated with cancer care in the US suggests that the annual figure could exceed 2 billion dollars for the first year following a diagnosis.
The study is published in today’s issue of the Journal of the National Cancer Institute.
The researchers, led by Dr Yabroff of the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI), used data covering 11 types of cancer from 760,000 patients whose records are in the Surveillance, Epidemiology, and End Results Medicare database. The records spanned 1995 to 2001. They also looked at information on 1.1 million Medicare members who did not have cancer for comparison.
The key question they tried to answer, in different ways, was how much extra time does having treatments for cancer, as opposed to non-cancer treatments, cost the average patient? This extra time they termed “net hours”. They estimated figures based on net hours and net costs by multiplying the hours by the median US wage rate (using the 2002 value of 15.23 dollars per hour).
They then looked at the database records and estimated the time that each patient spent actively waiting to be seen by a doctor or in a queue to receive treatment, for example in a hospital or emergency room. Time spent recovering from treatment at home was not included. Time spent in hospital before and after a treatment was included, as was time spent travelling to and from the treatment.
This type of study has not been done before – most estimates of cancer care focus on the direct costs of medical treatment and drugs.
One of the most revealing results was the wide variation in the costs among the 11 types of cancer, and also the influence of early versus late diagnosis.
For example, compared to similar people receiving non-cancer treatments, the net time (i.e. additional) spent by patients in cancer care ranged from nearly 18 hours for melanoma to over 350 hours for gastric and ovarian cancer.
And, in the first 12 months following a diagnosis, gastric and ovarian cancers had the highest average hospitalization time (21.1 and 20.8 days respectively). The shortest times were for patients with melanoma, prostate and breast cancer (2.2, 3.8 and 4.0 days respectively).
Applying the median wage rate to the time spent in the first 12 months following diagnosis, the net patient time cost from 271 dollars for melanoma to over 5,000 dollars for gastric and ovarian cancers.
The researchers also found that the earlier a cancer was diagnosed, the less treatment required and the lower the patient time cost.
Talking about the national burden, the NCI researchers said that in 2005 “the estimated cost for the initial phase of care alone was approximately $2.3 billion”.
The NCI team hope that when added to the direct and indirect costs of medical care and drugs these figures will help policy makers understand more clearly the nature of the cancer care burden in the country.
At first glance, using a monetary basis as a way to compare the costs to the patient of having one as opposed to another type of cancer, or not having cancer at all but some other disease seems a pointless academic exercise – what about the enormous emotional cost?
The researchers acknowledge this and point to the fact that with this kind of measure it is possible to compare, for the first time from the patients’ perspective, the “burden” that different treatments represent, the differences between phases of care, between early and late diagnosis, and the availability and intensity of treatment.
“Patient Time Costs Associated With Cancer Care.”
K. Robin Yabroff, William W. Davis, Elizabeth B. Lamont, Angela Fahey, Marie Topor, Martin L. Brown and Joan L. Warren.
Journal of the National Cancer Institute 2007, Volume 99, Number 1, Pp. 14-23
JNCI 2007 99(1):14-23; doi:10.1093/jnci/djk001
Written by: Catharine Paddock
Writer: Medical News Today