Presentation Authors: Maxine Sun*, Maya Marchese, David Fallon Friedlander, Alexander Putnam Cole, Sean Anthony Fletcher, Toni K. Choueiri, Adam S. Kibel, Quoc-Dien Trinh, Boston, MA
Introduction: Our objective was to examine health care spending patterns and what contributes to costs for the top 5% of health care users based on total payments made within the SEER Medicare prostate cancer population.
Methods: Men aged â‰¥66 year old with a primary diagnosis of PCa in 2009 (-60 days and +365 days of continuous follow-up), were identified. High resource spenders, defined as the top 5% of the sum of the total cost incurred for all services rendered per beneficiary within MedPar, Outpatient, and Carrier files for all patients identified. The bivariate relationship of patient and disease characteristics, sociodemographic, as well as regional characteristics associated with being a high resource spender will be examined. The most common and the most costly services rendered according to high resource spending status will be characterized. The odds of being a high resource spender will be assessed via multivariable linear regression model.
Results: Overall, 12,875 men with a primary diagnosis of PCa in 2009 were identified. The total cost incurred for all patients was $241800495 (mean $18781, median $13408). Of that amount, the top 5% spenders comprised of 646 men who spent a total of $62474504, whereas the bottom 95% spenders comprised of 12229 men who spent a total of $179325991. In general, the top 5% spenders of PCa in 2009 were older, sicker at diagnosis, more likely to be Black, and less likely to be married compared to the bottom 95% spenders (all P < 0.001 Table 2). The top 5% spenders were also more likely to harbour metastatic disease (14% vs. 3%) compared to their 95% counterparts. Of all costs incurred at the inpatient level the average cost of PCa related and non PCa related care among the top 5% spenders was $22625 and $28767 vs $13151 and $13908 among the bottom 95% spenders, respectively. Of all costs incurred at the Outpatient level, the average cost of PCa related and non PCa related care among the top 5% spenders was $1418 and $1011 vs. $1297 and $770 among the bottom 95% spenders, respectively. The ten most frequent PCa-related procedures for the top 5% and bottom 95% spenders were similar in nature, but differed according to average cost per procedure. After multivariable adjustment, more advanced disease stage, unmarried men, higher CCI, and those living in a high Medicare spending health service area had higher odds of being a top 5% spender than their counterparts.
Conclusions: The top 5% spenders of PCa account for 25% of all health care cost incurred for all men with a primary diagnosis of PCa in 2009.
Source of Funding: Brigham Research Institute, Bruce A. Beal and Robert L. Beal Surgical Fellowship, Conquer Cancer Foundation, Defense Health Agency, Intuitive Surgical, Prostate Cancer Foundation, Vattikuti Urology Institute.Maxine Sun is supported by an American Urologic