ONCOLOGY. Vol. 21 No. 7

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YOUR OLDER PATIENT

Cost Considerations in the Management of Cancer in the Older Patient

By June M. McKoy, Md, MPH¹, Karen A. Fitzner, PhD², Beatrice J. Edwards, MD³, Motasem Alkhatib, MD⁴, Cara C. Tigue, BA⁵, Narissa J. Nonzee, BS⁶, Carlos R. Bolden, BS⁷, Charles L. Bennett, MD, PhD, MPP⁸ | June 1, 2007

¹Division of Geriatrics ²Research Associate, Division of Hematology/Oncology ³Assistant Professor, Division of Geriatrics ⁴Research Collaborator, Division of Hematology/Oncology ⁵Project Coordinator, Division of Hematology/Oncology ⁶Project Coordinator, Division of Hematology/Oncology ⁷Research Assistant/MD Candidate ⁸Professor of Medicine, Buehler Professor of Geriatrics and Economics, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Division of Hematology/Oncology, Chicago, Illinois

Cost is the value that must be released in order to acquire a good or service. It may be total, fixed, or variable. Total cost refers to what is needed to operate at some particular rate of output. Fixed and variable costs are subsets of total cost, where fixed cost never changes, no matter how much service is used by the patient, and variable cost fluctuates depending on service utilization. Charges (patient bills) are often used as a proxy for cost. Charges may bear little resemblance to economic cost, and use of charges as a proxy for economic cost may be misleading relative to economic efficiency. Charges are based on actual prices for services provided and are sometimes aggregated into routine charges (room rates) and ancillary charges (the price of a tablet).

Summary

The total economic burden of cancer (all age groups) is more than Cost vs Charges

09 billion, with older populations accounting for a disproportionate amount of this expenditure. As the population in the United States continues to age, both the incidence and prevalence of cancer will increase, exerting an increased societal financial burden. Currently, 60% of all malignant tumors and 69% of all cancer deaths occur in persons 65 years and older. Furthermore, the leading types of cancers associated with mortality in the elderly (lung, colon, prostate, and breast) levy a significant financial burden on this population.

The total economic burden of cancer (all age groups) is more than $209 billion, with older populations accounting for a disproportionate amount of this expenditure. As the population in the United States continues to age, both the incidence and prevalence of cancer will increase, exerting an increased societal financial burden. Currently, 60% of all malignant tumors and 69% of all cancer deaths occur in persons 65 years and older. Furthermore, the leading types of cancers associated with mortality in the elderly (lung, colon, prostate, and breast) levy a significant financial burden on this population.

While older patients may benefit from longer disease-free survival and potential cure because of aggressive cancer therapy, the increased cost associated with concomitant supportive care, extended length of hospital stay, home health assistance following discharge from the hospital, and adjuvant prescription medications impose a significant financial burden on this group of patients.[40,41] Direct medical expenditures covered by third-party insurers represent the largest, but not the only, component of the total economic burden of cancer. OOPE paid by the patient and the family is estimated to account for as much as 10% of direct medical expenditures. Lost time and economic productivity associated with cancer-related illness and death are undoubtedly important, but are as yet undetermined for older individuals.[22]

Conclusions

The cost of cancer care in the older individual remains both a clinical and policy concern, particularly for those currently undergoing treatment or who have a prior history of cancer. A concerted effort is needed to provide appropriate treatment modalities against a cost-effective backdrop to this population. Clinical trials that now recruit older patients in their evaluation of potential anticancer drugs are poised to make significant contributions to the body of knowledge. Although some encouraging changes have been effected in clinical trials relative to recruitment of older subjects, more sweeping measures need to be implemented. Undoubtedly, more research is needed to understand all the costs incurred for cancer in older individuals, in an effort to effectuate reforms of private and federal reimbursement schemes aimed at achieving equity, quality, and access to affordable cancer care for older individuals.

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This article reviewed

Costs of Treating Elderly Patients With Cancer: What Are We Measuring in the Absence of Reliable Evidence?

The Moving Target of Cancer Care Costs

AMBUJ KUMAR, MD, MPH and BENJAMIN DJULBEGOVIC, MD, PhD
GARY H. LYMAN, MD, MPH, FRCP (EDIN)

The authors appreciate Eric Schmid's development of the targeted drug cost table (Table 1).

This article is part on an ongoing series, Your Older Patient, which is guest edited by Lodovico Balducci, md, Professor of Oncology and Medicine, and Director of the Division of Geriatric Oncology, University of South Florida College of Medicine and H. Lee Moffitt Cancer Center, Tampa, Florida.

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Cost Considerations in the Management of Cancer in the Older Patient

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