Several studies have estimated the direct medical costs of cancer care, but few have attempted to include a patient's time associated with cancer care, such as time spent traveling to and from care, waiting for appointments, and receiving services and treatments, all of which represent time not spent working or pursuing day-to-day activities.
In the new study, Robin Yabroff, Ph.D., of the National Cancer Institute, and colleagues quantified the patient time costs associated with cancer care. They used information from the Surveillance, Epidemiology, and End Results–Medicare database on more than 760,000 patients with 11 different types of cancer and from 1.1 million Medicare enrollees without cancer. Using data from 1995 to 2001, they estimated each patient's time spent at physician and emergency room visits, chemotherapy treatments, radiation therapy, hospitalizations, outpatient surgeries, and imaging procedures. They then estimated how long each patient spent traveling to, waiting for, and receiving care. The net costs were calculated using a dollar value of $15.23 per hour, the median U.S. wage rate in 2002.
During the first 12 months after diagnosis, the average length of time for hospitalization was highest for patients with gastric and ovarian cancers (21.1 and 20.8 days) and shortest for patients with melanoma (2.2 days), prostate cancer (3.8 days) and breast cancer (4.0 days). Compared to similar people without cancer, cancer patients' net time associated with medical care varied, ranging from 17.8 hours for melanoma to 351.3 hours for gastric cancer and 368.1 hours for ovarian cancer. When the researchers applied the dollar costs to time spent on medical care in the first 12 months after diagnosis, they found that net patient time costs were lowest for melanoma ($271) and prostate cancer ($842) and highest for gastric ($5,348) and ovarian ($5,605) cancer.
In the last year of life, hospitalization time was longest for patients with gastric (35.4 days), lung (32.4 days), and ovarian (31.9 days) cancer. Estimates of patients' net time spent on medical care were lowest for melanoma (99.1 hours) and highest for ovarian (485.3 hours), lung (488.3 hours), and gastric (512.2 hours) cancer. They calculated that the net patient time costs during the last year of life ranged from $1,509 for melanoma to $7,799 for gastric, $7,435 for lung, and $7,388 for ovarian cancer. Hospitalizations were the largest component of patient time costs in both the initial year after diagnosis and in the last year of life.
"For 2005, the estimated cost for the initial phase of care alone was approximately $2.3 billion," the authors write. These estimates could be combined with estimates of direct and indirect costs to better understand the overall burden of cancer in the United States, the authors write.
"What we see here is a measure of the patient's burden of commitment--measured in dollars--associated with receiving today's cancer therapy," write Larry G. Kessler, Sc.D., of the U.S. Food and Drug Administration and Scott D. Ramsey, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, in an accompanying editorial. "We hope that policy makers recognize the substantial economic burden of cancer in the United States and that this cost derives from many sources ?."
The editorial writers also note that these calculations do not address the emotional cost cancer patients and their families endure. Even accounting for patient time costs, "we know we have greatly underestimated the true cost of the disease," they write. Nevertheless, Kessler and Ram sey conclude, new treatments that reduce patient time costs should be encouraged, and manufacturers should quantify these benefits and then convey them to patients, providers, and health insurers.