title: Utilization and cost of health care services associated with primary malignant brain tumors in the United States.
abstract: OBJECTIVE
  To evaluate the economic burden of primary malignant brain tumors in a commercially insured population in the United States, and to identify the primary drivers of health care resource use and cost.
  
  
  METHODS
  A retrospective cohort analysis was performed using a 1998-2000 database containing inpatient, outpatient, and pharmacy claims for employees, their dependents, and early retirees of over 50 large US employers with wide geographic distribution. Patients were followed from first brain tumor diagnosis until death, termination of health benefits coverage, or study end. Controls without any cancer diagnosis were matched at a 3:1 ratio by demographic characteristics and length of follow-up.
  
  
  RESULTS
  Patients with malignant brain tumors (n = 653) had significantly greater health service utilization and costs for hospitalizations, emergency room visits, outpatient office visits, laboratory tests, radiology services, and pharmacy-dispensed drugs (all P < 0.05) than did controls (n = 1959). Regression-adjusted mean monthly costs were $6364 for brain tumor patients, compared with $277 for controls (P < 0.0001). The primary cost driver was inpatient care ($4502 per month). Total costs during the study period were $49,242 for those with brain tumors and $2790 for controls (P < 0.0001).
  
  
  CONCLUSIONS
  Patients with malignant brain tumors accrued health care costs that were 20 times greater than demographically matched control subjects without cancer. The costs for inpatient services were the primary drivers of total health resource use. Despite their low incidence, primary malignant brain tumors produce a substantial burden on the US health care system. There is a marked need for improved and new approaches to treatment to reduce the resource use and to offset health care costs associated with this disease.
authors.affiliation: Global Health Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, DC 1833, Indianapolis, IN 46285, USA. kutikova_lucie@lilly.com
authors.forename: Lucie
authors.initials: L
authors.lastname: Kutikova
authors.forename: Lee
authors.initials: L
authors.lastname: Bowman
authors.forename: Stella
authors.initials: S
authors.lastname: Chang
authors.forename: Stacey R
authors.initials: SR
authors.lastname: Long
authors.forename: Donald E
authors.initials: DE
authors.lastname: Thornton
authors.forename: William H
authors.initials: WH
authors.lastname: Crown
mesh_terms: D001932:Brain Neoplasms / Q000191:economics* / Q000628:therapy; D015331:Cohort Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics*; D016555:Matched-Pair Analysis; D012189:Retrospective Studies; D014481:United States