title: Lung cancer treatment costs, including patient responsibility, by disease stage and treatment modality, 1992 to 2003.
abstract: OBJECTIVE
  The objective of this analysis was to estimate costs for lung cancer care and evaluate trends in the share of treatment costs that are the responsibility of Medicare beneficiaries.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1991-2003 for 60,231 patients with lung cancer were used to estimate monthly and patient-liability costs for clinical phases of lung cancer (prediagnosis, staging, initial, continuing, and terminal), stratified by treatment, stage, and non-small- versus small-cell lung cancer. Lung cancer-attributable costs were estimated by subtracting each patient's own prediagnosis costs. Costs were estimated as the sum of Medicare reimbursements (payments from Medicare to the service provider), co-insurance reimbursements, and patient-liability costs (deductibles and "co-payments" that are the patient's responsibility). Costs and patient-liability costs were fit with regression models to compare trends by calendar year, adjusting for age at diagnosis.
  
  
  RESULTS
  The monthly treatment costs for a 72-year-old patient, diagnosed with lung cancer in 2000, in the first 6 months ranged from $2687 (no active treatment) to $9360 (chemo-radiotherapy); costs varied by stage at diagnosis and histologic type. Patient liability represented up to 21.6% of care costs and increased over the period 1992-2003 for most stage and treatment categories, even when care costs decreased or remained unchanged. The greatest monthly patient liability was incurred by chemo-radiotherapy patients, which ranged from $1617 to $2004 per month across cancer stages.
  
  
  CONCLUSIONS
  Costs for lung cancer care are substantial, and Medicare is paying a smaller proportion of the total cost over time.
authors.affiliation: Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cipriano
authors.forename: Dorothy
authors.initials: D
authors.lastname: Romanus
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.forename: Pamela M
authors.initials: PM
authors.lastname: McMahon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000473:pathology / Q000628:therapy; D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D003669:Deductibles and Coinsurance / Q000191:economics / Q000639:trends; D005382:Financing, Personal / Q000191:economics / Q000639:trends*; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000639:trends; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy; D006278:Medicare / Q000191:economics*; D055752:Small Cell Lung Carcinoma / Q000191:economics / Q000473:pathology / Q000628:therapy; D013727:Terminal Care / Q000191:economics; D014481:United States