Gastric Cancer Treatment Costs in the US Vary by Region
Regional variation exists in the treatment costs for patients with curative gastric cancer despite guidelines promoting appropriate care and health care delivery, according to a presentation at the 2018 ASCO Gastrointestinal Cancers Symposium (January 18-20, 2018; San Francisco, CA).
While gastric cancer remains difficult to treat, little is known about the economic burden of the disease. Multiple guidelines describe the curative treatment landscape for gastric cancer in a universal health care system, in which equal access and uniform health care delivery is expected. However, a common belief is that regional variation in practice exists and likely results in increased health care costs.
A group of Canadian researchers led by Yunni Jeong, MD, University of Toronto, investigated the costs of treating curative gastric cancer and explored regional variation in costs as well as identified factors that drive these costs. Researchers conducted a patient-level cost analysis of curative-intent stage I-III gastric cancer diagnosed from 2005 through 2008 from the perspective of a universal health care system, using a 26-month time horizon. A total of 722 patients were enrolled in the study.
Clinical and stage data were abstracted from a provincial chart review. Administrative health care databases provided costs associated with physician billings, same day surgery, hospitalization, drug benefits, ED visits, continuing care, and long-term care. These incurred costs—which were inflated to 2017 United States dollars—were compared among health care regions.
Results of the study showed that mean costs per region ranged from $55,650 to $92,852 across 14 health care regions. The lowest contributing cost sector was long-term care, while the highest contributing cost sector was from hospital admissions.
A linear regression model identified a laparoscopic surgical approach as predictive of lower costs, while age 70 or over and death at one year from diagnosis was predictive of higher costs.
Dr Jeong and colleagues concluded that regional variation exists in the treatment costs for patients with curative gastric cancer despite guidelines directing appropriate care and health care delivery in a universal health care system. They further cautioned that government intervention is needed to ensure quality care delivery across regions for curative gastric cancer.—Zachary Bessette