Medical Service Use and Charges for Cancer Care in 2018 for Privately Insured Patients Younger Than 65 Years in the US

Importance Currently, there are limited published data regarding resource use and spending on cancer care in the US. Objective To characterize the most frequent medical services provided and the associated spending for privately insured patients with cancer in the US. Design, Setting, and Participants This cohort study used data from the MarketScan database for the calendar year 2018 from a sample of 27.1 million privately insured individuals, including patients with a diagnosis of the 15 most prevalent cancers, predominantly from large insurers and self-insured employers. Overall societal health care spending was estimated for each cancer type by multiplying the mean total spending per patient (estimated from MarketScan) by the number of privately insured patients living with that cancer in 2018, as reported by the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Analyses were performed from February 1, 2018, to July 8, 2021. Exposures Evaluation and management as prescribed by treating care team. Main Outcomes and Measures Current Procedural Terminology and Healthcare Common Procedure Coding System codes based on cancer diagnosis code. Results The estimated cost of cancer care in 2018 for 402 115 patients with the 15 most prevalent cancer types was approximately $156.2 billion for privately insured adults younger than 65 years in the US. There were a total of 38.4 million documented procedure codes for 15 cancers in the MarketScan database, totaling $10.8 billion. Patients with breast cancer contributed the greatest total number of services (10.9 million [28.4%]), followed by those with colorectal cancer (3.9 million [10.2%]) and prostate cancer (3.6 million [9.4%]). Pathology and laboratory tests contributed the highest number of services performed (11.7 million [30.5%]), followed by medical services (6.3 million [16.4%]) and medical supplies and nonphysician services (6.1 million [15.9%]). The costliest cancers were those of the breast ($3.4 billion [31.5%]), followed by lung ($1.1 billion [10.2%]) and colorectum ($1.1 billion [10.2%]). Medical supplies and nonphysician services contributed the highest total spent ($4.0 billion [37.0%]), followed by radiology ($2.1 billion [19.4%]) and surgery ($1.8 billion [16.7%]). Conclusions and Relevance This analysis suggests that patients with breast, colorectal, and prostate cancers had the greatest number of services performed, particularly for pathology and laboratory tests, whereas patients with breast, lung, lymphoma, and colorectal cancer incurred the greatest costs, particularly for medical supplies and nonphysician services. The cost of cancer care in 2018 for the 15 most prevalent cancer types was estimated to be approximately $156.2 billion for privately insured adults younger than 65 years in the US. This cohort study uses 2018 data from the MarketScan database to characterize the most frequent medical services provided and the associated spending for privately insured patients with cancer in the US. Question What are the most common and costly medical procedures and services provided to privately insured patients with cancer in the US? Findings This cohort study found that the total estimated cost of cancer care for privately insured adults in the US was $156.2 billion. Patients with breast, colorectal, and prostate cancers had the greatest number of services performed, particularly for pathology and laboratory tests, and patients with breast, lung, and colorectal cancer incurred the highest costs, particularly for medical supplies and nonphysician services. Meaning This study suggests that, for privately insured patients with cancer, pathology and laboratory services contributed the most to the number of services performed, but medical supplies and nonphysician services contributed the most to spending.

Automated summary

This study analyzed the data from the 2018 MarketScan database to characterize the most common medical services provided and the associated spending for privately insured patients with cancer in the US. It was found that breast, colorectal, and prostate cancers had the highest number of services performed, particularly in pathology and laboratory tests, while breast, lung, and colorectal cancer incurred the highest costs, especially in medical supplies and nonphysician services. The total estimated cost of cancer care for privately insured adults in the US was $156.2 billion.