The Cost of Breast Cancer in California

Institution: University of California, San Francisco
Investigator(s): Wendy Max, Ph.D. -
Award Cycle: 2003 (Cycle IX) Grant #: 9PB-0025 Award: $315,198
Award Type: Request for Applications
Research Priorities
Community Impact of Breast Cancer>Health Policy and Health Services: better serving women's needs

Initial Award Abstract (2003)
Breast cancer is a disease that affects a large number of women of all ages, from young mothers to retired grandmothers. The resulting economic burden of the disease is huge, and includes dollars spent to diagnose and treat women, the value of time lost from productive activities by those living with the disease, and the value of the lives lost prematurely. Estimates of the cost of the illness have proven to be valuable for decision makers in comparing alternative treatments and service delivery systems, determining what groups of people should be targeted to receive improved access to care, and determining program budgets. Advocates have found the estimates helpful in persuading others to focus on this costly disease. However, current estimates of the cost of breast cancer in California are unavailable at the state level. This study will develop estimates of these costs using econometric models and approaches that utilize the best available data.

This project will provide several measures of the economic cost of breast cancer in California. Annual costs will include dollars spent on health care services, the value of lost productivity resulting from time lost for those living with cancer, and the value of lost productivity resulting from premature death from the disease. We will also estimate the lifetime cost of breast cancer over the course of the disease for older women on Medicare and look at how it varies by age and stage at diagnosis and by the type of treatment initially received.

We will estimate the cost of breast cancer using large datasets available from the state and federal government. Annual health care costs will be estimated by adding up the dollars spent for women with a primary diagnosis of breast cancer. We will also include the additional costs for women with other diagnoses but who have a secondary diagnosis of breast cancer. Hospital costs can be estimated in considerable detail, and the other types of costs are built upon these. Lost productivity costs will be estimated by valuing the time lost as a result of breast cancer at market wages and an imputed value for household production. Lifetime costs are estimated by comparing the total lifetime Medicare expenditures for women with and without breast cancer assuming they are the same in every other way. The difference between these costs is the lifetime cost of breast cancer.

The project will provide the first detailed estimates of the cost of breast cancer at the state level that have been made in over 17 years. Annual cost estimates will be available by age and race/ethnicity, allowing for comparisons among various subgroups of the population. The study will also provide California-specific estimates of lifetime costs of the disease, with separate estimates for women who receive different initial treatments. These data will permit policymakers and advocates to provide economic input to a number of activities and programs that focus on breast cancer.

Final Report (2006)
This study estimated the cost of breast cancer in California. The two objectives were to estimate 1) the annual costs of breast cancer for California women for 2001 including direct costs (hospitalizations, physician services, emergency department visits, medications, home health care, and nursing home care) and lost productivity costs from premature death, and 2) lifetime Medicare cost of breast cancer for California women.

In 2001, there were 12,934 hospital discharges of California women with a primary diagnosis of breast cancer. The average length of stay was 2.2 days, the mean cost was $5967, and total costs were $77 million. Mean costs decreased with age and were greatest for MediCal recipients. Hospital outpatient visits totaled $69 million and office-based provider visits totaled $56 million. Prescription medications and nursing home care added $19 million and $15 million in costs respectively. The total direct costs of breast cancer in California for 2001 were $279 million.

Breast cancer claimed the lives of 4,226 California women in 2001. Mortality rates increased with age, from 6.4 per 100,000 women aged 18-44, to 159.6 per 100,000 women aged 85 and older. These deaths cost the state dearly, representing $1.1 billion in the value of lost productivity and nearly 100,000 years of life lost. Each life lost prematurely to breast cancer represents lost productivity of $272,000 and 22.9 life years.

Lifetime cancer-attributable Medicare costs were estimated as the difference between the lifetime discounted costs for the cancer group and a control group that had been matched with cases by age and race. Costs were estimated by age, race/ethnicity, stage at diagnosis, and initial treatment modality. The mean cost across all women with breast cancer was $31,735. Cancer-attributable lifetime Medicare costs decreased with age at diagnosis, ranging from $37,306 for women diagnosed at age 65-69 to $19,493 for women age 85 and older at diagnosis. Total lifetime cancer-attributable Medicare costs were higher for Hispanics ($49,895) than for women of other racial/ethnic background. African Americans had the next highest lifetime costs ($40,451) while non-Hispanic whites had the lowest costs ($30,300). Stage at diagnosis had an important impact on lifetime cancer-attributable costs, with costs increasing substantially for women diagnosed at later stages. Lifetime Medicare cancer-attributable costs increased from $21,320 for women diagnosed with in situ cancer, to $26,747 for localized cancer, $40,096 for regional cancer, and $52,288 for distant cancer. The pattern of costs by stage across phases of care was similar using the AJC staging categories (stages 0-4). Lifetime cancer-attributable Medicare costs were estimated for 5 different treatment regimes. Costs differed by treatment according to stage of diagnosis. The highest lifetime Medicare cancer-attributable costs were for women diagnosed with advanced stage cancer and treated surgically ($49,383) and the lowest costs were for those diagnosed with AJC Stage 0 cancer and treated with modified radical mastectomy alone ($16,063).

These findings will be useful for policymakers and advocates wanting to target prevention, screening, and treatment dollars to the women who bear the greatest economic burden as a result of breast cancer.