Economic disparities in treatment costs among ambulatory Medicaid cancer patients.
BACKGROUND
Cancer is the second leading cause of death in the United States and a major contributor to healthcare expenditure. There are few studies examining disparities in treatment costs. Studies that do exist are dominated by the cost of hospital care.


METHODS
Utilizing Maryland Medicaid administrative claims data, a retrospective cohort, design was employed to examine disparities in ambulatory treatment costs of breast, colorectal and prostate cancer treatment by region, race and gender. We report mean and median results by each demographic category and test for the statistical significance of each. Lorenz curves are plotted and Gini coefficients calculated for each type of cancer.


RESULTS
We do not find a consistent trend in ambulatory costs across the three cancers by traditional demographic variables. Lorenz curves indicate highly unequal distributions of costs. Gini coefficients are 0.687 for breast cancer, 0.757 for colorectal cancer and 0.774 for prostate cancer.


CONCLUSIONS
Significant variation in nonhospital-based expenditures exists for breast, colorectal and prostate cancers in a population of homogeneous socioeconomic status and uniform insurance entitlement. Observed individual-level disparities are not consistent across cancers by region, race or gender, but the majority of this low-income population receives very little ambulatory care.
Mullins
C Daniel
CD
University of Maryland School of Pharmacy, Pharmaceutical Health Services Research Department, 515 W. Lombard St., Second Floor, Baltimore MD 21201, USA. dmullins@rx.umaryland.edu
Snyder
Stephen E
SE
Wang
Junling
J
Cooke
Jesse L
JL
Baquet
Claudia
C
D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D001943:Breast Neoplasms / Q000191:economics* / Q000628:therapy; D015179:Colorectal Neoplasms / Q000191:economics* / Q000628:therapy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008396:Maryland; D008484:Medicaid / Q000191:economics*; D011471:Prostatic Neoplasms / Q000191:economics* / Q000628:therapy; D019035:Rural Health Services / Q000191:economics; D019037:Urban Health Services / Q000191:economics*