Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-27 (of 27 Records) |
Query Trace: Trogdon JG [original query] |
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Cost-effectiveness of pharmacologic treatment options for women with endocrine-refractory or triple-negative metastatic breast cancer
Wheeler SB , Rotter J , Gogate A , Reeder-Hayes KE , Drier SW , Ekwueme DU , Fairley TL , Rocque GB , Trogdon JG . J Clin Oncol 2022 41 (1) Jco2102473 PURPOSE: Treatments for endocrine-refractory or triple-negative metastatic breast cancer (mBC) are modestly effective at prolonging life and improving quality of life but can be extremely expensive. Given these tradeoffs in quality of life and cost, the optimal choice of treatment sequencing is unclear. Cost-effectiveness analysis can explicitly quantify such tradeoffs, enabling more informed decision making. Our objective was to estimate the societal cost-effectiveness of different therapeutic alternatives in the first- to third-line sequences of single-agent chemotherapy regimens among patients with endocrine-refractory or triple-negative mBC. METHODS: Using three dynamic microsimulation models of 10,000 patients each, three cohorts were simulated, based upon prior chemotherapy exposure: (1) unexposed to either taxane or anthracycline, (2) taxane- and anthracycline-exposed, and (3) taxane-exposed/anthracycline-naive. We focused on the following single-agent chemotherapy regimens as reasonable and commonly used options in the first three lines of therapy for each cohort, based upon feedback from oncologists treating endocrine-refractory or triple-negative mBC: (1) for taxane- and anthracycline-unexposed patients, paclitaxel, capecitabine (CAPE), or pegylated liposomal doxorubicin; (2) for taxane- and anthracycline-exposed patients, Eribulin, CAPE, or carboplatin; and (3) for taxane-exposed/anthracycline-naive patients, pegylated liposomal doxorubicin, CAPE, or Eribulin. RESULTS: In each cohort, accumulated quality-adjusted life-years were similar between regimens, but total societal costs varied considerably. Sequences beginning first-line treatment with paclitaxel, carboplatin, and CAPE, respectively, for cohorts 1, 2, and 3, had lower costs and similar or slightly better outcomes compared with alternative options. CONCLUSION: In this setting where multiple single-agent chemotherapy options are recommended by clinical guidelines and share similar survival and adverse event trajectories, treatment sequencing approaches that minimize costs early may improve the value of care. |
Productivity costs associated with metastatic breast cancer in younger, midlife, and older women
Trogdon JG , Liu X , Reeder-Hayes KE , Rotter J , Ekwueme DU , Wheeler SB . Cancer 2020 126 (18) 4118-4125 BACKGROUND: The objective of the current study was to estimate productivity costs due to metastatic breast cancer (mBC) via productive time lost among survivors and potential life-years lost from premature mortality among 3 age groups: younger (aged 18-44 years), midlife (aged 45-64 years), and older (aged >/=65 years) women. METHODS: The authors estimated the number of work and home productivity days missed due to mBC by age group using data from the 2000 to 2016 National Health Interview Survey. Years of potential life lost (YPLL) due to mBC were calculated for each age group using 2015 National Vital Statistics System data. The authors valued both sources of lost productivity time using the Current Population Survey and prior studies. RESULTS: The per-woman value of lost productive days (work and home) due to mBC ranged from $680 for older women to $5169 for younger women. In 2015, the value of lost work and home productivity days associated with mBC nationally was $67 million for younger women, $246 million for midlife women, and $66 million for older women. YPLL were highest among midlife women (403,786 life-years), followed by older women (248,522 life-years) and younger women (95,943 life-years). Midlife women were found to have the highest market value of YPLL ($4.1 billion), followed by younger women ($1.6 billion) and older women ($527 million). CONCLUSIONS: The results of the current study demonstrated that mBC generates a high economic burden through lost productivity, especially among midlife women. |
Medical costs associated with metastatic breast cancer in younger, midlife, and older women
Trogdon JG , Baggett CD , Gogate A , Reeder-Hayes KE , Rotter J , Zhou X , Ekwueme DU , Fairley TL , Wheeler SB . Breast Cancer Res Treat 2020 181 (3) 653-665 PURPOSE: We estimated average medical costs due to metastatic breast cancer (mBC) among younger (aged 18-44), midlife (aged 45-64), and older women (aged 65 and older) by phase of care: initial, continuing, and terminal. METHODS: We used 2003-2014 North Carolina cancer registry data linked with administrative claims from public and private payers. We developed a claims-based algorithm to identify breast cancer patients who progressed to metastatic disease. We matched breast cancer patients (mBC and earlier stage) to non-cancer patients on age group, county of residence, and insurance plan. Outcomes were average monthly medical expenditures and expected medical expenditures by phase. We used regression to estimate excess costs attributed to mBC as the difference in mean payments between patients with mBC (N = 4806) and patients with each earlier-stage breast cancer (stage 1, stage 2, stage 3, and unknown stage; N = 21,772) and non-cancer controls (N = 109,631) by treatment phase and age group. RESULTS: Adjusted monthly costs for women with mBC were significantly higher than for women with earlier-stage breast cancer and non-cancer controls for all age groups and treatment phases except the initial treatment among women with stage 3 breast cancer at diagnosis. The largest expected total costs were for women aged 18-44 with mBC during the continuing phase ($209,961 95% Confidence Interval $165,736-254,186). CONCLUSIONS: We found substantial excess costs for mBC among younger women and during the continuing and terminal phases of survivorship. It is important to assess whether this care is high value for these women. |
Economics of public health programs for underserved populations: a review of economic analysis of the National Breast and Cervical Cancer Early Detection Program
Khushalani JS , Trogdon JG , Ekwueme DU , Yabroff KR . Cancer Causes Control 2019 30 (12) 1351-1363 PURPOSE: The purpose of this paper is to provide a brief overview of economic analysis methods used in estimating the costs and benefits of public health programs and systematically review the application of these methods to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS: Published literature on economic analyses of the NBCCEDP was systematically reviewed. The Consensus on Health Economic Criteria checklist was used to assess methodological quality of the included studies. RESULTS: Methods available for economic analysis of public health programs include program cost, cost-effectiveness, cost-utility, cost-benefit analysis, and budget impact analysis. Of these, program cost analysis, cost-effectiveness analysis, and cost-utility analysis have been applied to the NBCCEDP in previously published literature. CONCLUSION: While there have been multiple program cost analyses, there are relatively fewer cost-effectiveness and cost-utility studies and no cost-benefit and budget impact analysis studies to evaluate the NBCCEDP. Addressing these gaps will inform implementation of effective public health programs with equitable resource allocation to all population subgroups. |
The effect of delivery structure on costs, screening and health promotional services in state level National Breast and Cervical Cancer Early Detection Programs
Trogdon JG , Ekwueme DU , Subramanian S , Miller JW , Wong FL . Cancer Causes Control 2019 30 (8) 813-818 PURPOSE: We estimated the costs and effectiveness of state programs in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) based on the type of delivery structure. METHODS: Programs were classified into three delivery structures: (1) centralized, (2) decentralized, and (3) mixed. Centralized programs offer clinical services in satellite offices, but all other program activities are performed centrally. Decentralized programs contract with other entities to fully manage and provide screening and diagnostic services and other program activities. Programs with mixed service delivery structures have both centralized and decentralized features. Programmatic costs were averaged over a 3 year period (2006-2007, 2008-2009, and 2009-2010). Effectiveness was defined in terms of the average number of women served over the 3 years. We report costs per woman served by program activity and delivery structure and incremental cost effectiveness by program structure and by breast/cervical services. RESULTS: Average costs per woman served were lowest for mixed program structures (breast = $225, cervical = $216) compared to decentralized (breast = cervical = $276) and centralized program structures (breast = $259, cervical = $251). Compared with decentralized programs, for each additional woman served, centralized programs saved costs of $281 (breast) and $284 (cervical). Compared with decentralized programs, for each additional woman served, mixed programs added an additional $109 cost for breast but saved $1,777 for cervical cancer. CONCLUSIONS: Mixed program structures were associated with the lowest screening and diagnostic costs per woman served and had generally favorable incremental costs relative to the other program structures. |
Awardee-specific economic costs of providing cancer screening and health promotional services to medically underserved women eligible in the National Breast and Cervical Cancer Early Detection Program
Subramanian S , Ekwueme DU , Miller JW , Khushalani JS , Trogdon JG , Wong FL . Cancer Causes Control 2019 30 (8) 827-834 OBJECTIVES: To estimate awardee-specific costs of delivering breast and cervical cancer screening services in their jurisdiction and to assess potential variation in the cost of key activities across awardees. METHODS: We developed the cost assessment tool to collect resource use and cost data from the National Breast and Cervical Cancer Early Detection Program awardees for 3 years between 2006 and 2010 and generated activity-based cost estimates. We estimated awardee-specific cost per woman served for all activities, clinical screening delivery services, screening promotion interventions, and overarching program support activities. RESULTS: The total cost per woman served by the awardees varied greatly from $205 (10th percentile) to $499 (90th percentile). Differences in the average (median) cost per person served for clinical services, health promotion interventions, and overarching support activities ranged from $51 to $125. CONCLUSIONS: The cost per woman served varied across awardee and likely reflected underlying differences across awardees in terms of screening infrastructure, population served, and barriers to screening uptake. Collecting information on contextual factors at the awardee, health system, provider, and individual levels may assist in understanding this variation in cost. |
Estimation of breast cancer incident cases and medical care costs attributable to alcohol consumption among insured women aged <45 years in the U.S
Ekwueme DU , Allaire BT , Parish WJ , Thomas CC , Poehler D , Guy GP Jr , Aldridge AP , Lahoti SR , Fairley TL , Trogdon JG . Am J Prev Med 2017 53 S47-s54 INTRODUCTION: This study estimated the percentage of breast cancer cases, total number of incident cases, and total annual medical care costs attributable to alcohol consumption among insured younger women (aged 18-44 years) by type of insurance and stage at diagnosis. METHODS: The study used the 2012-2013 National Survey on Drug Use and Health, cancer incidence data from two national registry programs, and published relative risk measures to estimate the: (1) alcohol-attributable fraction of breast cancer cases among younger women by insurance type; (2) total number of breast cancer incident cases attributable to alcohol consumption by stage at diagnosis and insurance type among younger women; and (3) total annual medical care costs of treating breast cancer incident cases attributable to alcohol consumption among younger women. Analyses were conducted in 2016; costs were expressed in 2014 U.S. dollars. RESULTS: Among younger women enrolled in Medicaid, private insurance, and both groups, 8.7% (95% CI=7.4%, 10.0%), 13.8% (95% CI=13.3%, 14.4%), and 12.3% (95% CI=11.4%, 13.1%) of all breast cancer cases, respectively, were attributable to alcohol consumption. Localized stage was the largest proportion of estimated attributable incident cases. The estimated total number of breast cancer incident alcohol-attributable cases was 1,636 (95% CI=1,570, 1,703) and accounted for estimated total annual medical care costs of $148.4 million (95% CI=$140.6 million, $156.1 million). CONCLUSIONS: Alcohol-attributable breast cancer has estimated medical care costs of nearly $150 million per year. The current findings could be used to support evidence-based interventions to reduce alcohol consumption in younger women. |
Medical costs of treating breast cancer among younger medicaid beneficiaries by stage at diagnosis
Trogdon JG , Ekwueme DU , Poehler D , Thomas CC , Reeder-Hayes K , Allaire BT . Breast Cancer Res Treat 2017 166 (1) 207-215 BACKGROUND: Younger women (aged 18-44 years) diagnosed with breast cancer often face more aggressive tumors, higher treatment intensity, and lower survival rates than older women. In this study, we estimated incident breast cancer costs by stage at diagnosis and by race for younger women enrolled in Medicaid. METHODS: We analyzed cancer registry data linked to Medicaid claims in North Carolina from 2003 to 2008. We used Surveillance, Epidemiology, and End Results (SEER) Summary 2000 definitions for cancer stage. We split breast cancer patients into two cohorts: a younger and older group aged 18-44 and 45-64 years, respectively. We conducted a many-to-one match between patients with and without breast cancer using age, county, race, and Charlson Comorbidity Index. We calculated mean excess total cost of care between breast cancer and non-breast cancer patients. RESULTS: At diagnosis, younger women had a higher proportion of regional cancers than older women (49 vs. 42%) and lower proportions of localized cancers (44 vs. 50%) and distant cancers (7 vs. 9%). The excess costs of breast cancer (all stages) for younger and older women at 6 months after diagnosis were $37,114 [95% confidence interval (CI) = $35,769-38,459] and $28,026 (95% CI = $27,223-28,829), respectively. In the 6 months after diagnosis, the estimated excess cost was significantly higher to treat localized and regional cancer among younger women than among older women. There were no statistically significant differences in excess costs of breast cancer by race, but differences in treatment modality were present among younger Medicaid beneficiaries. CONCLUSIONS: Younger breast cancer patients not only had a higher prevalence of late-stage cancer than older women, but also had higher within-stage excess costs. |
A new methodological approach to adjust alcohol exposure distributions to improve the estimation of alcohol-attributable fractions
Parish WJ , Aldridge A , Allaire B , Ekwueme DU , Phelps D , Guy GP Jr , Thomas CC , Trogdon JG . Addiction 2017 112 (11) 2053-2063 BACKGROUND AND AIMS: To assess the burden of excessive alcohol use, researchers routinely estimate alcohol-attributable fractions (AAFs). However, underreporting in survey data can bias these estimates. We present an approach that adjusts for underreporting in the estimation of AAFs, particularly across subgroups. This framework is a refinement of a previous method (Rehm et al., 2010). METHODS: We use a measurement error model to derive the "true" alcohol distribution from a "reported" alcohol distribution. The "true" distribution leverages per capita sales data to identify the distribution average and then identifies the shape of the distribution with self-reported survey data. Data are from the National Alcohol Survey (NAS), the National Household Survey on Drug Abuse (NHSDA), and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We compared our approach with previous approaches by estimating the AAF of female breast cancer cases. RESULTS: Compared with Rehm et al.'s approach, our refinement performs similarly under a gamma assumption. For example, among females aged 18-25, the two approaches produce estimates from NHSDA that are within a percentage point. However, relaxing the gamma assumption generally produces more conservative evidence. For example, among females aged 18-25, estimates from NHSDA based on the best-fitting distribution are only 19.33 percent of breast cancer cases, which is a much smaller proportion than the gamma-based estimates of about 28 percent. CONCLUSIONS: A refinement of Rehm et al.'s approach to adjusting for underreporting in the estimation of alcohol-attributable fractions provides more flexibility. This flexibility can avoid biases associated with failing to account for the underlying differences in alcohol consumption patterns across different study populations. Comparisons of our refinement with Rehm et al.'s approach show that results are similar when a gamma distribution is assumed. However, results are appreciably lower when the best-fitting distribution is chosen versus gamma-based results. |
Breast cancer treatment costs in younger, privately insured women
Allaire BT , Ekwueme DU , Poehler D , Thomas CC , Guy GP Jr , Subramanian S , Trogdon JG . Breast Cancer Res Treat 2017 164 (2) 429-436 PURPOSE: Younger women (under age 45 years) diagnosed with breast cancer often face more aggressive tumors, higher treatment intensity, lower survival rates, and greater financial hardship. The purpose of this study was to estimate breast cancer costs by stage at diagnosis during the first 18 months of treatment for privately insured younger women. METHODS: We analyzed North Carolina cancer registry data linked to claims data from private insurers from 2003 to 2010. Breast cancer patients were split into two cohorts: a younger and older group aged 21-44 and 45-64 years, respectively. We conducted a cohort study and matched women with and without breast cancer using age, ZIP, and Charlson Comorbidity Index. We calculated mean excess costs between breast cancer and non-breast cancer patients at 6, 12, and 18 months. RESULTS: For younger women, AJCC 6th edition stage II cancer was the most common at diagnosis (40%), followed by stage I (34%). On the other hand, older women had more stage I (46%) cancer followed by stage II (34%). The excess costs for younger and older women at 12 months were $97,486 (95% confidence interval [CI] $93,631-101,341) and $75,737 (95% CI $73,962-77,512), respectively. Younger breast cancer patients had both a higher prevalence of later-stage disease and higher within-stage costs. CONCLUSIONS: The study reports high costs of treatment for both younger and older women than a non-cancer comparison group; however, the estimated excess cost was significantly higher for younger women. The financial implications of breast cancer treatment costs for younger women need to be explored in future studies. |
Treatment costs of breast cancer among younger women aged 19-44 years enrolled in Medicaid
Ekwueme DU , Allaire BT , Guy GP Jr , Arnold S , Trogdon JG . Am J Prev Med 2016 50 (2) 278-85 INTRODUCTION: A few studies have examined the costs of breast cancer treatment in a Medicaid population at the state level. However, no study has estimated medical costs for breast cancer treatment at the national level for women aged 19-44 years enrolled in Medicaid. METHODS: A sample of 5,542 younger women aged 19-44 years enrolled in fee-for-service Medicaid with diagnosis codes for breast cancer in 2007 were compared with 4.3 million women aged 19-44 years enrolled in fee-for-service Medicaid without breast cancer. Nonlinear regression methods estimated prevalent treatment costs for younger women with breast cancer compared with those without breast cancer. Individual medical costs were estimated by race/ethnicity and by type of services. Analyses were conducted in 2013 and all medical treatment costs were adjusted to 2012 U.S. dollars. RESULTS: The estimated monthly direct medical costs for breast cancer treatment among younger women enrolled in Medicaid was $5,711 (95% CI=$5,039, $6,383) per woman. The estimated monthly cost for outpatient services was $4,058 (95% CI=$3,575, $4,541), for inpatient services was $1,003 (95% CI=$708, $1,298), and for prescription drugs was $539 (95% CI=$431, $647). By race/ethnicity, non-Hispanic white women had the highest monthly total medical costs, followed by Hispanic women and non-Hispanic women of other race. CONCLUSIONS: Cost estimates demonstrate the substantial medical costs associated with breast cancer treatment for younger Medicaid beneficiaries. As the Medicaid program continues to evolve, the treatment cost estimates could serve as important inputs in decision making regarding planning for treatment of invasive breast cancer in this population. |
Medical care costs of breast cancer in privately insured women aged 18-44 years
Allaire BT , Ekwueme DU , Guy GP Jr , Li C , Tangka FK , Trivers KF , Sabatino SA , Rodriguez JL , Trogdon JG . Am J Prev Med 2016 50 (2) 270-7 INTRODUCTION: Breast cancer in women aged 18-44 years accounts for approximately 27,000 newly diagnosed cases and 3,000 deaths annually. When tumors are diagnosed, they are usually aggressive, resulting in expensive treatment costs. The purpose of this study is to estimate the prevalent medical costs attributable to breast cancer treatment among privately insured younger women. METHODS: Data from the 2006 MarketScan(R) database representing claims for privately insured younger women were used. Costs for younger breast cancer patients were compared with a matched sample of younger women without breast cancer, overall and for an active treatment subsample. Analyses were conducted in 2013 with medical care costs expressed in 2012 U.S. dollars. RESULTS: Younger women with breast cancer incurred an estimated $19,435 (SE=$415) in additional direct medical care costs per person per year compared with younger women without breast cancer. Outpatient expenditures comprised 94% of the total estimated costs ($18,344 [SE=$396]). Inpatient costs were $43 (SE=$10) higher and prescription drug costs were $1,048 (SE=$64) higher for younger women with breast cancer than in younger women without breast cancer. For women in active treatment, the burden was more than twice as high ($52,542 [SE=$977]). CONCLUSIONS: These estimates suggest that breast cancer is a costly illness to treat among younger, privately insured women. This underscores the potential financial vulnerability of women in this age group and the importance of health insurance during this time in life. |
Productivity costs associated with breast cancer among survivors aged 18-44 years
Ekwueme DU , Trogdon JG , Khavjou OA , Guy GP Jr . Am J Prev Med 2016 50 (2) 286-94 INTRODUCTION: No study has quantified productivity losses associated with breast cancer in younger women aged 18-44 years. This study estimated productivity costs, including work and home productivity losses, among younger women who reported ever receiving a breast cancer diagnosis. METHODS: A two-part regression model and 2000-2010 National Health Interview Survey data were used to estimate the number of work and home productivity days missed because of breast cancer, adjusted for socioeconomic characteristics and comorbidities. Estimates for younger women were compared with those for women aged 45-64 years. Data were analyzed in 2013-2014. RESULTS: Per capita, younger women with breast cancer had annual losses of $2,293 (95% CI=$1,069, $3,518) from missed work and $442 (95% CI=$161, $723) from missed home productivity. Total annual breast cancer-associated productivity costs for younger women were $344 million (95% CI=$154 million, $535 million). Older women with breast cancer had lower per capita work loss productivity costs of $1,407 (95% CI=$899, $1,915) but higher total work loss productivity costs estimated at $1,072 million (95% CI=$685 million, $1,460 million) than younger women. CONCLUSIONS: Younger women with a history of breast cancer face a disproportionate share of work and home productivity losses. Although older women have lower per capita costs, total productivity costs were higher for older women because the number of older women with breast cancer is higher. The results underscore the importance of continued efforts by the public health community to promote and support the unique needs of younger breast cancer survivors. |
The economics of breast cancer in younger women in the U.S.: The present and future
Ekwueme DU , Trogdon JG . Am J Prev Med 2016 50 (2) 249-54 In the past four decades, substantial progress has been made in breast cancer survival in part because of advances in early detection and treatment following diagnosis.1,2 Further, recent studies3,4 have reported that the observed improvement in breast cancer mortality and survival between the 1970s and 2000s is also the result of changes in the distribution of tumor characteristics, which include the identification of the human epidermal growth factor receptor 2 and the development of the targeted agent such as trastuzumab that extends survival in both the adjuvant and metastatic settings for a range of 15%–25% of patients with human epidermal growth factor receptor 2–positive tumors. For example, in 2012, the annual age-adjusted breast cancer mortality was approximately 21 per 100,000 and 5-year relative survival exceeded 90%.5 Despite this progress, not all age, racial/ethnic, or socioeconomic groups have benefited equally, and disparities in incidence and mortality still exist.6 During the past four decades, incidence of breast cancer was much higher in older women (aged >50 years) and the survival rate was lower in younger women (aged <50 years).7 This is in part because breast cancer in women aged 15–44 years (henceforth referred to as younger women) is often characterized by aggressive tumor subtypes that are less likely to be amenable to treatment at the time of diagnosis and have poorer survival outcomes.8–11 As a result, these breast cancers could result in more devastating health outcomes and economic burden to younger women, their families, and society. |
Health state utility impact of breast cancer in U.S. women aged 18-44 years
Brown DS , Trogdon JG , Ekwueme DU , Chamiec-Case L , Guy GP Jr , Tangka FK , Li C , Trivers KF , Rodriguez JL . Am J Prev Med 2016 50 (2) 255-61 INTRODUCTION: Breast cancer affects women's health-related quality of life negatively, but little is known about how breast cancer affects this in younger women aged 18-44 years. This study measures preference-based health state utility (HSU) values, a scaled index of health-related quality of life for economic evaluation, for younger women with breast cancer and compares these values with same-age women with other cancers and older women (aged ≥45 years) with breast cancer. METHODS: Data from the 2009 and 2010 Behavioral Risk Factor Surveillance System were analyzed in 2014. The sample included 218,852 women; 7,433 and 18,577 had histories of breast and other cancers. HSU values were estimated using Healthy Days survey questions and a published mapping algorithm. Linear regression models for HSU were estimated by age group (18-44 and ≥45 years). RESULTS: The adjusted breast cancer HSU impact was four times larger for younger women than for older women (-0.097 vs -0.024, p<0.001). For younger women, the effect of breast cancer on HSU was 70% larger than that of other cancers (-0.097 vs -0.057, p=0.024). CONCLUSIONS: Younger breast cancer survivors reported lower HSU values than older survivors, highlighting the impact of breast cancer on the physical and mental health of younger women. The estimates may be used to evaluate quality-adjusted life-years or expectancy for prevention or treatment of breast cancer. This study also indicates that separate quality of life adjustments for women by age group are important for economic analysis of public health breast cancer interventions. |
Breast cancer in young women: Health state utility impacts by race/ethnicity
Trogdon JG , Ekwueme DU , Chamiec-Case L , Guy GP Jr . Am J Prev Med 2016 50 (2) 262-9 INTRODUCTION: Little is known about the effect of breast cancers on health-related quality of life among women diagnosed between age 18 and 44 years. The goal of this study is to estimate the effect of breast cancer on health state utility by age at diagnosis (18-44 years versus ≥45 years) and by race/ethnicity. METHODS: The analytic sample, drawn from the 2009 and 2010 Behavioral Risk Factor Surveillance System and analyzed in 2013, included women diagnosed with breast cancer between age 18 and 44 years (n=1,389) and age ≥45 years (n=6,037). Health state utility values were estimated using Healthy Days variables and a published algorithm. Regression analysis was conducted separately by age at diagnosis and race/ethnicity. RESULTS: The breast cancer health state utility decrement within 1 year from date of diagnosis was larger for women diagnosed at age 18-44 years than for women diagnosed at age ≥45 years (-0.116 vs -0.070, p<0.05). Within the younger age-at-diagnosis group, Hispanic women 2-4 years after diagnosis had the largest health state utility decrement (-0.221, p<0.01), followed by non-Hispanic white women within 1 year of diagnosis (-0.126, p<0.01). CONCLUSIONS: This study is the first to report estimates of health state utility values for breast cancer by age at diagnosis and race/ethnicity from a nationwide sample. The results highlight the need for separate quality of life adjustments for women by age at diagnosis and race/ethnicity when conducting cost-effectiveness analysis of breast cancer prevention, detection, and treatment. |
Costs of chronic diseases at the state level: the Chronic Disease Cost Calculator
Trogdon JG , Murphy LB , Khavjou OA , Li R , Maylahn CM , Tangka FK , Nurmagambetov TA , Ekwueme DU , Nwaise I , Chapman DP , Orenstein D . Prev Chronic Dis 2015 12 E140 INTRODUCTION: Many studies have estimated national chronic disease costs, but state-level estimates are limited. The Centers for Disease Control and Prevention developed the Chronic Disease Cost Calculator (CDCC), which estimates state-level costs for arthritis, asthma, cancer, congestive heart failure, coronary heart disease, hypertension, stroke, other heart diseases, depression, and diabetes. METHODS: Using publicly available and restricted secondary data from multiple national data sets from 2004 through 2008, disease-attributable annual per-person medical and absenteeism costs were estimated. Total state medical and absenteeism costs were derived by multiplying per person costs from regressions by the number of people in the state treated for each disease. Medical costs were estimated for all payers and separately for Medicaid, Medicare, and private insurers. Projected medical costs for all payers (2010 through 2020) were calculated using medical costs and projected state population counts. RESULTS: Median state-specific medical costs ranged from $410 million (asthma) to $1.8 billion (diabetes); median absenteeism costs ranged from $5 million (congestive heart failure) to $217 million (arthritis). CONCLUSION: CDCC provides methodologically rigorous chronic disease cost estimates. These estimates highlight possible areas of cost savings achievable through targeted prevention efforts or research into new interventions and treatments. |
Using simulation to compare established and emerging interventions to reduce cardiovascular disease risk in the United States
Homer J , Wile K , Yarnoff B , Trogdon JG , Hirsch G , Cooper L , Soler R , Orenstein D . Prev Chronic Dis 2014 11 E195 INTRODUCTION: Computer simulation offers the ability to compare diverse interventions for reducing cardiovascular disease risks in a controlled and systematic way that cannot be done in the real world. METHODS: We used the Prevention Impacts Simulation Model (PRISM) to analyze the effect of 50 intervention levers, grouped into 6 (2 x 3) clusters on the basis of whether they were established or emerging and whether they acted in the policy domains of care (clinical, mental health, and behavioral services), air (smoking, secondhand smoke, and air pollution), or lifestyle (nutrition and physical activity). Uncertainty ranges were established through probabilistic sensitivity analysis. RESULTS: Results indicate that by 2040, all 6 intervention clusters combined could result in cumulative reductions of 49% to 54% in the cardiovascular risk-related death rate and of 13% to 21% in risk factor-attributable costs. A majority of the death reduction would come from Established interventions, but Emerging interventions would also contribute strongly. A slim majority of the cost reduction would come from Emerging interventions. CONCLUSION: PRISM allows public health officials to examine the potential influence of different types of interventions - both established and emerging - for reducing cardiovascular risks. Our modeling suggests that established interventions could still contribute much to reducing deaths and costs, especially through greater use of well-known approaches to preventive and acute clinical care, whereas emerging interventions have the potential to contribute significantly, especially through certain types of preventive care and improved nutrition. |
Cost of services provided by the National Breast and Cervical Cancer Early Detection Program
Ekwueme DU , Subramanian S , Trogdon JG , Miller JW , Royalty JE , Li C , Guy GP , Crouse W , Thompson H , Gardner JG . Cancer 2014 120 Suppl 16 2604-11 BACKGROUND: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is the largest cancer screening program for low-income women in the United States. This study updates previous estimates of the costs of delivering preventive cancer screening services in the NBCCEDP. METHODS: We developed a standardized web-based cost-assessment tool to collect annual activity-based cost data on screening for breast and cervical cancer in the NBCCEDP. Data were collected from 63 of the 66 programs that received funding from the Centers for Disease Control and Prevention during the 2006/2007 fiscal year. We used these data to calculate costs of delivering preventive public health services in the program. RESULTS: We estimated the total cost of all NBCCEDP services to be $296 (standard deviation [SD], $123) per woman served (including the estimated value of in-kind donations, which constituted approximately 15% of this total estimated cost). The estimated cost of screening and diagnostic services was $145 (SD, $38) per women served, which represented 57.7% of the total cost excluding the value of in-kind donations. Including the value of in-kind donations, the weighted mean cost of screening a woman for breast cancer was $110 with an office visit and $88 without, the weighted mean cost of a diagnostic procedure was $401, and the weighted mean cost per breast cancer detected was $35,480. For cervical cancer, the corresponding cost estimates were $61, $21, $415, and $18,995, respectively. CONCLUSIONS: These NBCCEDP cost estimates may help policy makers in planning and implementing future costs for various potential changes to the program. |
State-level estimates of cancer-related absenteeism costs
Tangka FK , Trogdon JG , Nwaise I , Ekwueme DU , Guy GP Jr , Orenstein D . J Occup Environ Med 2013 55 (9) 1015-20 BACKGROUND: Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. METHODS: In analyses of data from the 2004-2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. RESULTS: We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. CONCLUSIONS: The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population. |
State-level cancer treatment costs: how much and who pays?
Tangka FK , Trogdon JG , Ekwueme DU , Guy GP Jr , Nwaise I , Orenstein D . Cancer 2013 119 (12) 2309-16 BACKGROUND: Cancer treatment accounts for approximately 5% of national health expenditures. However, no state-level estimates of cancer treatment costs have been published. METHODS: In analyses of data from the Medical Expenditure Panel Survey, the National Nursing Home Survey, the US Census Bureau, the Current Population Survey, and the Centers for Medicare & Medicaid Services, this study used regression modeling to estimate annual state-level cancer care costs during 2004 to 2008 for 4 categories of payers: all payers, Medicare, Medicaid, and private insurance. RESULTS: State-level cancer care costs ranged from $227 million to $13.6 billion (median = $2.0 billion) in 2010 dollars. Medicare paid between 25.1% and 36.1% of these costs (median = 32.5%); private insurance paid between 36.0% and 49.6% (median = 43.3%); and Medicaid paid between 2.0% and 8.8% (median = 4.8%). Cancer treatment accounted for 3.8% to 8.7% of all state-level medical expenditures (median = 7.0%), 8.5% to 15.0% of state-level Medicare expenditures (median = 10.6%), 1.0% to 4.9% of state-level Medicaid expenditures (median = 2.2%), and 5.5% to 10.9% of state-level private insurance expenditures (median = 8.7%). CONCLUSIONS: The costs of cancer treatment were substantial in all states and accounted for a sizable fraction of medical expenditures for all payers. The high cost of cancer treatment underscores the importance of preventing and controlling cancer as one approach to manage state-level medical costs. (Cancer 2013. (c) 2013 American Cancer Society.) |
State-level projections of cancer-related medical care costs: 2010 to 2020
Trogdon JG , Tangka FK , Ekwueme DU , Guy GP Jr , Nwaise I , Orenstein D . Am J Manag Care 2012 18 (9) 525-32 BACKGROUND: As the population ages, the financial amount spent on cancer care is expected to increase substantially. In this study, we projected cancer-related medical costs by state from 2010 through 2020. METHODS: We used pooled Medical Expenditure Panel Survey data for 2004 to 2008 and US Census Bureau population projections to produce state-level estimates of the number of people treated for cancer and the average cost of their treatment, from a health system perspective, by age group (18-44, 45-64, >65 years) and sex. In the base model, we assumed that the percentage of people in each of the 6 age-by-sex categories who had been treated for cancer would remain constant and that the inflation-adjusted average cancer treatment cost per person would increase at the same rate as Congressional Budget Office projections of overall medical spending. RESULTS: We projected that state-level cancer-related medical costs would increase by 34% to 115% (median = 72%) and that state-level costs in 2020 would range from $347 million to $28.3 billion in 2010 dollars (median = $3.7 billion). CONCLUSIONS: The number of people treated for cancer and the costs of their cancer-related medical care are projected to increase substantially for each state. Effective prevention and early detection strategies are needed to limit the growing burden of cancer. |
Obesity and severe obesity forecasts through 2030
Finkelstein EA , Khavjou OA , Thompson H , Trogdon JG , Pan L , Sherry B , Dietz W . Am J Prev Med 2012 42 (6) 563-70 BACKGROUND: Previous efforts to forecast future trends in obesity applied linear forecasts assuming that the rise in obesity would continue unabated. However, evidence suggests that obesity prevalence may be leveling off. PURPOSE: This study presents estimates of adult obesity and severe obesity prevalence through 2030 based on nonlinear regression models. The forecasted results are then used to simulate the savings that could be achieved through modestly successful obesity prevention efforts. METHODS: The study was conducted in 2009-2010 and used data from the 1990 through 2008 Behavioral Risk Factor Surveillance System (BRFSS). The analysis sample included nonpregnant adults aged ≥18 years. The individual-level BRFSS variables were supplemented with state-level variables from the U.S. Bureau of Labor Statistics, the American Chamber of Commerce Research Association, and the Census of Retail Trade. Future obesity and severe obesity prevalence were estimated through regression modeling by projecting trends in explanatory variables expected to influence obesity prevalence. RESULTS: Linear time trend forecasts suggest that by 2030, 51% of the population will be obese. The model estimates a much lower obesity prevalence of 42% and severe obesity prevalence of 11%. If obesity were to remain at 2010 levels, the combined savings in medical expenditures over the next 2 decades would be $549.5 billion. CONCLUSIONS: The study estimates a 33% increase in obesity prevalence and a 130% increase in severe obesity prevalence over the next 2 decades. If these forecasts prove accurate, this will further hinder efforts for healthcare cost containment. |
The economic implications of influenza vaccination for adults with asthma
Trogdon JG , Nurmagambetov TA , Thompson HF . Am J Prev Med 2010 39 (5) 403-10 BACKGROUND: Influenza vaccination is recommended for adults with asthma. PURPOSE: This study estimates the effect of influenza vaccination on utilization of medical services and expenditures for acute and chronic respiratory conditions (ACRC) among adults with asthma. METHODS: The sample was adults aged ≥18 years self-reporting asthma in the 2003 through 2006 Medical Expenditure Panel Survey (MEPS), covering four complete influenza seasons. The dependent variables were indicators for any ACRC claims within service category and ACRC expenditures. The main independent variable was an indicator of influenza vaccination. To control for selection bias in the observational data, a nonlinear instrumental variables approach was used. The instruments were indicators for influenza in the first year of MEPS and vaccination in the year prior to MEPS. Data were analyzed in 2009. RESULTS: Adults with asthma vaccinated for influenza were 4.4 percentage points less likely to have an inpatient stay due to ACRC (95% CI = -10.8, -1.0). Influenza vaccination was associated with a $492 decrease (95% CI = -$1591, -$56) in annual ACRC nonprescription expenditures, a $224 increase (95% CI = $70, $360) in annual ACRC prescription expenditures, and a nonsignificant $216 decrease (95% CI = -$854, $248) in overall annual ACRC expenditures. CONCLUSIONS: Although there was no evidence that vaccination reduced overall ACRC expenditures, the study suggests that efforts to increase the percentage of adults with asthma who are vaccinated may bring substantial benefits in terms of reducing the prevalence and costs of hospitalization although raising prescription medication costs, possibly through improvement in compliance. |
Cancer treatment cost in the United States: has the burden shifted over time?
Tangka FK , Trogdon JG , Richardson LC , Howard D , Sabatino SA , Finkelstein EA . Cancer 2010 116 (14) 3477-84 BACKGROUND: There has not been a comprehensive analysis of how aggregate cancer costs have changed over time. The authors present 1) updated estimates of the prevalence and total cost of cancer for select payers and how these have changed over the past 2 decades; and 2) for each payer, the distribution of payments by type of service over time to assess whether there have been shifts in cancer treatment settings. METHODS: Pooled data from the 2001 through 2005 Medical Expenditure Panel Survey and the 1987 National Medical Care Expenditure Survey were used for the analysis. The authors used an econometric approach to estimate cancer-attributable medical expenditures by payer and type of service. RESULTS: In 1987, the total medical cost of cancer (in 2007 US dollars) was $24.7 billion. Private payers financed the largest share of the total (42%), followed by Medicare (33%), out of pocket (17%), other public (7%), and Medicaid (1%). Between 1987 and the 2001 to 2005 period, the total medical cost of cancer increased to $48.1 billion. In 2001 to 2005, the shares of cancer costs were: private insurance (50%), Medicare (34%), out of pocket (8%), other public (5%), and Medicaid (3%). The share of total cancer costs that resulted from inpatient admissions fell from 64.4% in 1987 to 27.5% in 2001 to 2005. CONCLUSIONS: The authors identified 3 trends in the total costs of cancer: 1) the medical costs of cancer have nearly doubled; 2) cancer costs have shifted away from the inpatient setting; and 3) the share of these costs paid for by private insurance and Medicaid have increased. Cancer 2010. Published 2010 by American Cancer Society. |
The personal financial burden of cancer for the working-aged population
Finkelstein EA , Tangka FK , Trogdon JG , Sabatino SA , Richardson LC . Am J Manag Care 2009 15 (11) 801-6 OBJECTIVE: To present nationally representative estimates of the effect of cancer care on out-of-pocket medical expenditures and lost productivity for the working-aged population. STUDY DESIGN: Secondary data analysis. METHODS: Pooled data from the Medical Expenditure Panel Survey were used for the analysis. We constructed the following 4 respondent groups for comparison during the analysis period: (1) respondents with no cancer, and (among those who reported having cancer) (2) respondents with active cancer care, (3) respondents with follow-up Cancer care, and (4) respondents with no cancer care. Using regression analysis, we estimated the effect of being in each of the cancer care groups on out-of-pocket medical expenditures, the probability of being employed, and the annual number of workdays missed because of illness or injury. RESULTS: Being actively treated for cancer increases the mean annual out-of-pocket medical expenditures by $1170 compared with not having cancer. Less intensive cancer care is associated with lower medical expenditures (but still higher than for those without cancer). Respondents undergoing active cancer care were less likely to be employed full-time. Among respondents who were employed, those undergoing active cancer care missed 22.3 more workdays per year than those without cancer. CONCLUSION: Changes to the health system need to consider not only how to reduce inappropriate medical utilization but also how to ensure that those diagnosed as having cancer and other serious medical conditions will not be doubly burdened with poor health and high medical expenditures. |
Annual medical spending attributable to obesity: payer-and service-specific estimates
Finkelstein EA , Trogdon JG , Cohen JW , Dietz W . Health Aff (Millwood) 2009 28 (5) w822-31 In 1998 the medical costs of obesity were estimated to be as high as $78.5 billion, with roughly half financed by Medicare and Medicaid. This analysis presents updated estimates of the costs of obesity for the United States across payers (Medicare, Medicaid, and private insurers), in separate categories for inpatient, non-inpatient, and prescription drug spending. We found that the increased prevalence of obesity is responsible for almost $40 billion of increased medical spending through 2006, including $7 billion in Medicare prescription drug costs. We estimate that the medical costs of obesity could have risen to $147 billion per year by 2008. |
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