Economic burden of metastatic bone disease in the U.S.
BACKGROUND
Previous research has documented the prevalence of primary bone cancer; however, there are few data available regarding the impact of metastatic bone disease (MBD) on national expenditure. In this study, the authors quantified the prevalence and direct medical care costs of patients with MBD and the resulting cost impact on U.S. oncology expenditure.


METHODS
Anonymous, patient-level data on health care utilization and cost were obtained from the Thomson Medstat MarketScan research databases. In total, 396,200 patients who were diagnosed with cancer between 2000 and 2004 were selected for the study. Patients with MBD were matched subsequently to non-MBD controls. A 2-part linear regression model was used to compare cases with controls to quantify the incremental cost associated with the disease.


RESULTS
Cancer prevalence in the U.S. during the study period was estimated at 4,861,987 cases annually, and 5.3% (n=256,137) of those patients had MBD. Rates of MBD were highest in patients with multiple myeloma (28.8%) and lung cancer (15.6%). The mean direct medical cost for all cancers combined was $75,329 for patients with MBD and $31,382 for controls. Regression-adjusted, incremental costs were $44,442 (P<.001) across all cancer types. The incremental cost was highest for patients with multiple myeloma ($63,455) and lowest for patients with lung cancer ($24,946).


CONCLUSIONS
The national cost burden for patients with MBD was estimated at $12.6 billion, which is 17% of the $74 billion in total direct medical cost estimated by the National Institutes of Health, suggesting that MBD is a significant driver of overall oncology cost.
Schulman
Kathy L
KL
Outcomes Research & Econometrics, Thomson Healthcare, Cambridge, Massachusetts, USA. kathy.schulman@thomson.com
Kohles
Joseph
J
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000191:economics* / Q000556:secondary* / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology