Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service

Am Health Drug Benefits. 2016 Feb;9(1):23-32.


Background: Diagnosis of breast cancer at early stages is associated with better clinical and survival outcomes. How the costs of care vary depending on the stage at which breast cancer was diagnosed has not been thoroughly examined.

Objective: To quantify the stage-dependent average per capita cost of breast cancer treatment for a commercially insured population of women with newly diagnosed breast cancer.

Methods: This retrospective analysis of claims data was based on a population selected from the Truven Healthcare MarketScan commercial claims database. The study comprised women aged 18 to 64 years with breast cancer who had ≥2 claims in 2010 that were ≥30 days apart and included an International Classification of Diseases, Ninth Revision diagnosis code for breast cancer (174.xx, 233.0) in any position of the claim. Two years of postdiagnosis claims data were analyzed by stage at diagnosis (ie, 0, I/II, III, and IV).

Results: In total, 8360 women met the criteria for study inclusion (stage 0, N = 2300; stage I/II, N = 4425; stage III, N = 1134; and stage IV, N = 501). The costs were higher for patients whose cancer was more advanced at diagnosis, for all cumulative 6-month periods (months 0-6, 0-12, 0-18, and 0-24). The average costs per patient allowed by the insurance company in the year after diagnosis were $60,637, $82,121, $129,387, and $134,682 for disease stage 0, I/II, III, and IV, respectively. The average costs allowed per patient in the 24 months after the index diagnosis were $71,909, $97,066, $159,442, and $182,655 for disease stage 0, I/II, III, and IV, respectively. The cost difference based on the stage at diagnosis was largely driven by the cost of chemotherapy and noncancer treatments.

Conclusion: Treating advanced- versus early-stage breast cancer is associated with significant increases in incremental costs. Knowledge of the relevant stage-specific cost data provides support for strengthening programs, such as breast cancer screening, that are designed to shift breast cancer diagnosis to earlier disease stages.

Keywords: breast cancer; cancer stage; cost; diagnosis.