Proportion of patients with cancer among high-cost Medicare beneficiaries: Who they are and what drives their spending

Abstract

BackgroundA small proportion of patients account for the majority of health care spending. Of this group, little is known about what proportion have a cancer diagnosis and how their spending pattern compares to those without cancer. MethodsUsing national Medicare data of enrollees 65 or older, we identified patients in the top decile of spending in 2014 and designated them as high-cost. We used ICD-9 codes to identify patients with a cancer diagnosis and examined cancer prevalence among both high-cost and non-high-cost patients. We examined patterns of spending for high-cost patients with and without cancer. ResultsWhile 14.8% of all Medicare beneficiaries have a cancer diagnosis, we found that the prevalence of a cancer diagnosis was much higher among high-cost patients (32.5% versus 12.9% of non-high-cost patients). Thus, having a cancer diagnosis was associated with a 3.1 times greater odds of being high-cost, even after accounting for age (odds ratio 3.09, 95% CI 3.07–3.11; P < 0.001). High-cost patients with cancer had higher total annual spending than high-cost patients without cancer ($66,685 vs. $59,427; p < 0.0001); costs among high-cost cancer patients were driven by greater use of outpatient treatments (19.2% of total spending vs. 13.6% among non-cancer high-cost patients, p < 0.0001) and more prescription drugs (11.9% vs. 9.9%; p < 0.0001). ConclusionsThere is a high prevalence of cancer diagnoses among high-cost Medicare patients. ImplicationsPrograms that target high-cost patients may need to customize interventions based on whether the patient has a cancer diagnosis.