Cost and patterns of care among patients with advanced non-melanoma skin cancer.

Abstract

e16517 Background: Few studies examine health care utilization (HCU) and cost among basal cell carcinoma (BCC) patients. Although BCC has no specific ICD-9 code, it is known to constitute ~80% of all non-melanoma skin cancers (NMSC). More than 1 million new cases of NMSC were reported in the US in 2010, and there were ~1000 deaths due to NMSC. Methods: A claims-based analysis was conducted using data from January 2002 to March 2010 from a national commercial health insurer. Patients with ≥ 2 claims with a NMSC diagnosis (ICD-9-CM 173.xx) at least 60 days apart, or at least 1 claim for a skin cancer-specific excision with diagnosis code 173.xx were identified. Those with additional primary cancers were excluded. Patients were grouped into 1 of 3 cohorts: metastatic, locally advanced (LA), or “all other.” Metastatic patients had ≥ 2 claims with a metastasis code (ICD-9-CM 196.xx-198.xx) at least 30 days apart. LA patients had ≥ 2 visits with a medical oncologist, ≥ 1 diagnostic imaging service, ≥2 services for radiation therapy or ≥1 visit to 2 or more physician specialties. The remaining patients were “all other.” The time of first NMSC or metastatic disease diagnosis was considered the index date. Total HCU and average per-patient per-month (PPPM) costs during follow-up were estimated. Results: Among 188,795 patients, 155 (0.1%), 2,412 (1.3%) and 186,228 (98.6%) patients, were identified as metastatic, LA or “all other,” respectively with an overall mean follow-up of 917 days. Compared to “all others,” metastatic and LA patients were significantly older and had a higher baseline Charlson comorbidity index (0.64 vs. 2.08 and 1.46 respectively, p-value <0.01). Compared to “all others” and LA patients, more metastatic patients had inpatient stays (19% and 30% vs. 48% respectively, p-value <0.01) and emergency room visits (37% and 43% vs. 55% respectively, p-value <0.01). In addition, total PPPM costs for LA and metastatic patients were ~2x or ~3x higher, respectively, than costs for “all others (p-value <0.01). Conclusions: HCU and cost for NMSC (which includes ~80% BCC) increases significantly as disease advances. Effective treatment could reduce this burden.