Cost of breast cancer treatment and follow-up care in Medicaid beneficiaries: Implications for state programs providing coverage for low-income women.

Abstract

e12000 Background: In the United States, breast cancer imposes a considerable health and economic burden to society as well as to individuals, particularly to low-income women. In 2000, the U.S. Congress passed the Breast and Cervical Cancer Prevention and Treatment Act to give states the opportunity to provide medical assistance through Medicaid for women who were screened for and found to have breast cancer through the CDC's National Breast and Cervical Cancer Early Detection Program.To date, no study has reported on the cost of treating breast cancer among Medicaid beneficiaries aged < 65 years. This study assesses the incremental cost of breast cancer care among low-income women < 65 years of age eligible for Medicaid program in North Carolina (NC). Methods: Administrative data from the NC Medicaid program linked with cancer registry data were analyzed to derive monthly Medicaid costs for cancer patients and the incremental costs of breast cancer care at 6, 12 and 24 months from diagnosis. We compared 848 beneficiaries diagnosed with cancer during the years 2002 to 2004 with 1,696 controls matched on age. We used a two-part regression model to predict the impact of breast cancer diagnosis by stage. Results: The incremental costs (std error) of treating breast cancer relative to no cancer at 6 months after diagnosis were $11,350 ($760), $20,227 ($1,146), and $28,911 ($3,422) for those with local, regional and distant breast cancers, respectively. These costs increased 33.0%, 43.7%, and 50.6% at 12 months; and 39.3, 45.4, and 73.6% at 24 months, respectfully. Average monthly costs for those with local and regional cancers declined to the levels of non-cancer beneficiaries by 9 and 15 months respectively, while those with distant cancers remained higher through 24 months. Conclusions: The observed extended period of health care utilization, beyond the immediate 6-month period after diagnosis, indicates that Medicaid coverage may be required for many months after diagnosis to ensure the provision of adequate care. Late stage cancers may require more treatment and follow-up procedures; therefore, early detection of breast cancer could be expected to reduce the costs incurred by Medicaid. No significant financial relationships to disclose.