Estimating patient time costs associated with colorectal cancer care

Background: Nonmedical costs of care, such as patient time associated with travel to, waiting for, and seeking medical care, are rarely measured systematically with population-based data. Objectives: The purpose of this study was to estimate patient time costs associated with colorectal cancer care. Methods: We identified categories of key medical services for colorectal cancer care and then estimated patient time associated with each service category using data from national surveys. To estimate average service frequencies for each service category, we used a nested case control design and SEER-Medicare data. Estimates were calculated by phase of care for cases and controls, using data from 1995 to 1998. Average service frequencies were then combined with estimates of patient time for each category of service, and the value of patient time assigned. Net patient time costs were calculated for each service category, summarized by phase of care, and compared with previously reported net direct costs of colorectal cancer care. Results: Net patient time costs for the 3 phases of colorectal cancer care averaged $4592 (95% confidence interval [CI] $4427-4757) over the 12 months of the initial phase, $2788 (95% CI $2614-2963) over the 12 months of the terminal phase, and $25 (95% Cl: $23-26) per month in the continuing phase of care. Hospitalizations accounted for more than two thirds of these estimates. Patient time costs were 19.3% of direct medical costs in the initial phase, 15.8% in the continuing phase, and 36.8% in the terminal phase of care. Conclusions: Patient time costs are an important component of the costs of colorectal cancer care. Application of this method to other tumor sites and inclusion of other components of the costs of medical care will be important in delineating the economic burden of cancer in the United States.