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Healthcare utilization and cost of care in elderly breast cancer patients enrolled in SWOG clinical trials

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Importance

Patients with cancer are at risk for unplanned hospitalizations during treatment which can increase the cost of care.

Objectives

To determine demographic and clinical factors associated with healthcare utilization and costs among clinical trial participants.

Design, setting, and patients

We conducted a retrospective analysis among breast cancer patients over the age of 65 treated on SWOG clinical trials from 1999 to 2011 with trial data linked to Medicare claims.

Main outcomes and measures

The outcomes were healthcare utilization (emergency room visits (ER), hospitalizations) and costs from Medicare Claims. Demographic, clinical, and prognostic factors were captured from clinical trial records. We identified cardiovascular comorbidities/risk factors (CVD-RFs) of diabetes, hypertension, hypercholesterolemia, and coronary artery disease (CAD) from Medicare claims. Multivariable logistic and linear regression were used to assess the association between CVD-RFs and outcomes.

Results

Among the 708 patients included in the analysis, 160 (22.6%) experienced 234 separate hospitalizations, and 193 (27.3%) experienced 311 separate ER visits. Black race was associated with an increase in hospitalizations (OR [95% CI], 2.52 [1.10–5.79], p = 0.03), but not emergency room visits compared to white race. Diabetes, hypertension, hypercholesterolemia, and CAD were all independently associated with increased risk of both hospitalizations and ER visit. Hypertension had the strongest association, with more than a threefold risk of hospitalization for those with hypertension compared to those without (OR [95% CI], 3.16 [1.85–5.40], p < 0.001). For those with ≥ 3 RFs, the risk of hospitalization was nearly 3 times greater compared to 0 or 1 CVD-RFs (OR [95% CI], 2.74 [1.71–4.38], p < 0.001). Similar results were seen for ER visits. In the first 12 months after trial registration, patients with diabetes ($38,324 vs $30,923, 23.9% increase, p = 0.05), hypercholesterolemia ($34,168 vs $30,661, 11.4% increase, p = 0.02), and CAD ($37,781 vs $31,698, 19.2% increase, p = 0.04) had statistically significantly higher total healthcare costs. Additionally, those with ≥ 2 significant CVD-RFs ($35,353 vs. $28,899, 22.3% increase, p = 0.005) had statistically significantly higher total healthcare costs.

Conclusions

Among participants treated on clinical trials, black race and presence of multiple cardiovascular comorbidities was associated with a substantial increase in ER visits, hospitalizations and healthcare costs. Efforts to reduce unplanned hospitalizations should focus on this high-risk group.

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Acknowledgements

Dr. Hershman is the recipient of a NCORP Research Base grant 1UG1CA189974-01. Dr. Unger is a recipient of a grant from the HOPE Foundation. Dr. Hershman is the recipient of grants from the Conquer Cancer Foundation, the Breast Cancer Research Foundation, and the Susan G. Komen Research Foundation.

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Authors and Affiliations

  1. Columbia University Medical Center and the Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Avenue, 10-1068, New York, NY, 10032, USA

    Dawn L. Hershman, Jason D. Wright & Melissa Accordino

  2. SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Cathee Till, Riha Vaidya, William E. Barlow & Joseph M. Unger

  3. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Scott Ramsey

Authors
  1. Dawn L. Hershman
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  2. Cathee Till
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  3. Jason D. Wright
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  4. Melissa Accordino
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  5. Riha Vaidya
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  6. William E. Barlow
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  7. Scott Ramsey
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  8. Joseph M. Unger
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Correspondence to Dawn L. Hershman.

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Hershman, D.L., Till, C., Wright, J.D. et al. Healthcare utilization and cost of care in elderly breast cancer patients enrolled in SWOG clinical trials. Breast Cancer Res Treat 181, 455–463 (2020). https://doi.org/10.1007/s10549-020-05634-1

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  • DOI: https://doi.org/10.1007/s10549-020-05634-1

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