Impact of survival on health care charges during melanoma treatment.

Abstract

e20043 Background: Treatment charges increase during the last year of life in patients with melanoma, but it remains unknown if charges differ between patients who die during treatment and survivors. The objective of this study was to examine annualized mean charges by melanoma survival status. Methods: The University of Utah Enterprise Data Warehouse was used to analyze patients ≥18 years with a diagnosis of melanoma identified by ICD-9 code (first diagnosis defined as index date) treated at the Huntsman Cancer institute (HCI) from 2002-2010. The HCI tumor registry was used to determine stage at diagnosis and other cancer diagnoses. Cause and date of death was captured from the Utah Population Database. Cancer-related (CR) and non-CR charges were assessed by ICD-9 codes from index date until death or end of the follow-up period, were weighted by the inverse probability of survival, and annualized. Generalized linear models (GLM) with gamma distribution and log link function were used to examine charges by survival status, adjusting for baseline characteristics including demographics, disease stage, and comorbidities. Results: A total of 1205 patients were included, of which 218 (18%) died. Compared to alive patients, deceased patients were older (60 vs. 56), more female (40% vs. 28%), more were diagnosed with stage IV disease (19% vs. 3%), and less with stage I disease (26% vs. 66%) (all p≤0.001). Mean unadjusted annualized charges were not significantly different between the two groups for CR charges (deceased $15,109 vs. alive $14,519; p=0.89), but non-CR charges were higher for deceased patients ($77,390 vs. $18,719; p<0.001). GLM results indicated deceased patients, relative to survivors, had 59% higher annualized CR charges (p<0.001) overall, with higher CR charges at stages I and II (86% and 76%, respectively; both p<0.001), and lower CR charges at stage IV (-127%; p<0.001). Death was associated with 154% higher annualized non-CR charges (p<0.001) at stages I, II, III, and IV (210%, 167%, 119%, and 73%, respectively; all p<0.05). Conclusions: When adjusting for confounders, deceased melanoma patients had higher charges overall compared to melanoma survivors. The exception was for decreased CR charges in stage IV, most likely related to earlier death.