Patient Time Costs Associated With Cancer Care

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Abstract
Although costs of medical care for cancer have been investigated extensively, patient time costs associated with cancer care have rarely been estimated systematically. In this study, we estimated patient time costs associated with cancer care in patients aged 65 years and older in the United States. We identified 763 527 patients with breast, colorectal, corpus uteri, gastric, head and neck, lung, melanoma of the skin, ovary, prostate, renal, and urinary bladder cancers from linked Surveillance, Epidemiology, and End Results–Medicare files and 1 145 159 noncancer control subjects among Medicare enrollees who were matched by sex, age-group, and geographic location. Frequency of service use was calculated by category for patients and control subjects using Medicare claims data from 1995 to 2001. For each service category, time estimates were combined with service frequency and an hourly value of patient time. Net patient time costs were summed in the initial, continuing, and last-year-of-life phases of care for each tumor site. Net time cost estimates for the initial phase of care were applied to national estimates of numbers of new cancers in 2005 to obtain national time costs for the initial phase of care. Net patient time costs during the initial phase of care ranged from $271 (95% confidence interval [CI] = $213 to $329) and $842 (95% CI = $806 to $878) for melanoma of the skin and prostate cancer, respectively, to $5348 (95% CI = $4978 to $5718) and $5605 (95% CI = $5273 to $5937) for gastric and ovarian cancers, respectively. Net patient time costs for care during the last year of life ranged from $1509 (95% CI = $1343 to $1675) for melanoma of the skin to $7799 (95% CI = $7433 to $8165), $7435 (95% CI = $7207 to $7663), and $7388 (95% CI = $7018 to $7758) for gastric, lung, and ovarian cancers, respectively. In 2005, patient time costs for the initial phase of care were $2.3 billion. Patient time costs for cancer care in the United States are substantial and vary by tumor site and phase of care, likely reflecting differences in stage at diagnosis and availability and intensity of treatment.