COSTS OF CARE ASSOCIATED WITH NON-SMALL-CELL LUNG-CANCER IN A COMMERCIALLY INSURED COHORT

Purpose: To examine the cost of incident cases of non-small-cell lung cancer (NSCLC) in a commercially insured cohort. Methods: Claims from Virginia Blue Cross and Blue Shield (BCBS) beneficiaries with lung can cer from 1989 to 1991 were merged with records from the Virginia Cance r Registry (VCR). Data from the VCR identified incident cases, stage, and type of cancer at diagnosis, Costs for all medical care included i nsurance payment, copayments, and deductibles for 2 years after diagno sis or until death.Results: Three hundred forty-nine incident NSCLC pa tients were evaluated. The mean 9-year cost for each patient after dia gnosis or until death was $47,941 (95% confidence interval, $43,758 to $52,124). Total average costs and hospital days were significantly lo wer for local disease ($37,514, 21.2 days), but were similar for regio nal ($52,797, 30.0 days) and distant ($49,382, 33.0 days) disease. Hos pital days accounted for 48% and hospital-based claims for 70% of cost s. Initial treatments, which included radiation, unadjusted for stage, had the lowest survival rates and the highest costs, and were associa ted with the most hospital days. Initial stage, race, gender, and age were not predictors of total 5-year costs, The independent predictors of total 5-year costs were type of treatment: any radiation therapy, a ny surgery, or any chemotherapy (all, P < .001). Inpatient hospital da ys was only a modest predictor of costs after adjusting for type of tr eatment. Patients who survived less than 1 year spent 30.5 days in hos pital and had an average cost of $47,280. Conclusion: The direct healt h care costs of younger NSCLC patients care are substantial, These res ults should serve as a benchmark for future comparisons as the United States market shifts to managed care. (C) 1998 by American Society of Clinical Oncology.