title: Costs of care associated with non-small-cell lung cancer in a commercially insured cohort.
abstract: OBJECTIVE
  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 cancer from 1989 to 1991 were merged with records from the Virginia Cancer Registry (VCR). Data from the VCR identified incident cases, stage, and type of cancer at diagnosis. Costs for all medical care included insurance payment, copayments, and deductibles for 2 years after diagnosis or until death.
  
  
  RESULTS
  Three hundred forty-nine incident NSCLC patients were evaluated. The mean 2-year cost for each patient after diagnosis or until death was $47,941 (95% confidence interval, $43,758 to $52,124). Total average costs and hospital days were significantly lower for local disease ($37,514, 21.2 days), but were similar for regional ($52,797, 30.0 days) and distant ($49,382, 33.0 days) disease. Hospital days accounted for 48% and hospital-based claims for 70% of costs. Initial treatments, which included radiation, unadjusted for stage, had the lowest survival rates and the highest costs, and were associated with the most hospital days. Initial stage, race, gender, and age were not predictors of total 2-year costs. The independent predictors of total 2-year costs were type of treatment: any radiation therapy, any surgery, or any chemotherapy (all, P < .001). Inpatient hospital days was only a modest predictor of costs after adjusting for type of treatment. Patients who survived less than 1 year spent 30.5 days in hospital and had an average cost of $47,280.
  
  
  CONCLUSIONS
  The direct health care costs of younger NSCLC patients care are substantial. These results should serve as a benchmark for future comparisons as the United States market shifts to managed care.
authors.affiliation: Department of Internal Medicine, Medical College of Virginia and Massey Cancer Center, Virginia Commonwealth University, Richmond 23298-0170, USA. hillner@hsc.vcu.edu
authors.forename: B E
authors.initials: BE
authors.lastname: Hillner
authors.forename: M K
authors.initials: MK
authors.lastname: McDonald
authors.forename: C E
authors.initials: CE
authors.lastname: Desch
authors.forename: T J
authors.initials: TJ
authors.lastname: Smith
authors.forename: L T
authors.initials: LT
authors.lastname: Penberthy
authors.forename: P
authors.initials: P
authors.lastname: Maddox
authors.forename: S M
authors.initials: SM
authors.lastname: Retchin
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000628:therapy; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012042:Registries; D014768:Virginia