title: Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings.
abstract: OBJECTIVE
  This study provides population-based estimates of the treatment costs for elderly women with early-stage breast cancer, with emphasis on costs of modified radical mastectomy (MRM) compared with breast-conserving surgery (BCS) and radiation therapy (RT).
  
  
  METHODS
  Women with breast cancer from the Surveillance, Epidemiology, and End Results cancer registries were linked with their Medicare claims, 1990 through 1998. Each claim was assigned to an initial, continuing, or terminal care phase after a cancer diagnosis. Mean monthly phase-specific costs were determined for all health care and for treatment related only to cancer. Cumulative long-term costs of care that accrue during a women's remaining lifetime were calculated by treatment group.
  
  
  RESULTS
  Initial care costs for the 6 months after diagnosis for women who underwent BCS with RT were approximately $450 per month higher than for women with MRM. During the continuing-care phase, costs for women undergoing BCS with RT were significantly less expensive than for MRM cases. The two groups had similar costs in the terminal-care phase. Assuming the same survival distributions, long-term costs for women undergoing BCS with RT were not statistically different than for women undergoing MRM.
  
  
  CONCLUSIONS
  Although mastectomy was less costly in the initial phase, the lifetime costs of BCS with RT and mastectomy were equivalent. Thus, women's preferences, resources to cover out-of-pocket costs, and life situations should be the major factors addressed in shared decision making about treatment options.
authors.affiliation: Applied Research Program, National Cancer Institute, Executive Plaza North, Rm. 4005, 6130 Executive Blvd., Bethesda, MD 20892-7344, USA. joan_warren@nih.gov
authors.forename: Joan L
authors.initials: JL
authors.lastname: Warren
authors.forename: Martin L
authors.initials: ML
authors.lastname: Brown
authors.forename: Michael P
authors.initials: MP
authors.lastname: Fay
authors.forename: Nicola
authors.initials: N
authors.lastname: Schussler
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Riley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006285:Health Planning; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000191:economics*; D015412:Mastectomy, Segmental / Q000191:economics*; D006278:Medicare / Q000191:economics; D014481:United States