title: Relationship Between Quality of Comorbid Condition Care and Costs for Cancer Survivors.
abstract: To estimate the association between cancer survivors' comorbid condition care quality and costs; to determine whether the association differs between cancer survivors and other patients.
  
  
  
  Using the SEER-Medicare-linked database, we identified survivors of breast, prostate, and colorectal cancers who were diagnosed in 2004, enrolled in Medicare fee-for-service for at least 12 months before diagnosis, and survived ≥ 3 years. Quality of care was assessed using nine process indicators for chronic conditions, and a composite indicator representing seven avoidable outcomes. Total costs on the basis of Medicare amount paid were grouped as inpatient and outpatient. We examined the association between care quality and costs for cancer survivors, and compared this association among 2:1 frequency-matched noncancer controls, using comparisons of means and generalized linear regressions.
  
  
  
  Our sample included 8,661 cancer survivors and 17,332 matched noncancer controls. Receipt of recommended care was associated with higher outpatient costs for eight indicators, and higher inpatient and total costs for five indicators. For three measures (visit every 6 months for patients with chronic obstructive pulmonary disease or diabetes, and glycosylated hemoglobin or fructosamine every 6 months for patients with diabetes), costs for cancer survivors who received recommended care increased less than for noncancer controls. The absence of avoidable events was associated with lower costs of each type. An annual eye examination for patients with diabetes was associated with lower inpatient costs.
  
  
  
  Higher-quality processes of care may not reduce short-term costs, but the prevention of avoidable outcomes reduces costs. The association between quality and cost was similar for cancer survivors and noncancer controls.
authors.affiliation: Johns Hopkins University Carey Business School; Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada kfrick@jhu.edu.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.affiliation: Johns Hopkins University Carey Business School; Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Claire F
authors.initials: CF
authors.lastname: Snyder
authors.affiliation: Johns Hopkins University Carey Business School; Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herbert
authors.affiliation: Johns Hopkins University Carey Business School; Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.affiliation: Johns Hopkins University Carey Business School; Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.affiliation: Johns Hopkins University Carey Business School; Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Wolff
authors.affiliation: Johns Hopkins University Carey Business School; Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carducci
authors.affiliation: Johns Hopkins University Carey Business School; Johns Hopkins University School of Medicine; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000191:economics* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare; D011471:Prostatic Neoplasms / Q000191:economics* / Q000453:epidemiology; D011787:Quality of Health Care / Q000191:economics*; D018426:SEER Program; D017741:Survivors; D014481:United States