Research Article: Cancer Treatment for Dual Eligibles: What Are the Costs and Who Pays?

Date Published: March 23, 2018


Author(s): Susan G. Haber, Florence K.L. Tangka, Lisa C. Richardson, Susan A. Sabatino, David Howard.



This study quantifies treatment costs for melanoma and breast, cervical, colorectal, lung, and prostate cancer among patients with dual Medicare and Medicaid eligibility. The analyses use merged Medicare and Medicaid Analytic eXtract enrollment and claims data for dually eligible beneficiaries age>18 in Georgia, Illinois, Louisiana, and Maine in 2003 (n=892,001). We applied ordinary least squares regression analysis to estimate annual expenditures attributable to each cancer after controlling for beneficiaries’ age, race/ethnicity, sex, and comorbid conditions, and state fixed effects. Cancers and comorbid conditions were identified on the basis of diagnosis codes on insurance claims. The most prevalent cancers were prostate (38.4 per 1,000 men) and breast (30.7 per 1,000 women). Dual eligibles with the study cancers had higher rates of other chronic conditions such as hypertension and arthritis than other beneficiaries. Total Medicare and Medicaid expenditures for dual eligibles with the study cancers ranged from $30,328 for those with lung cancer to $17,011 for those with breast cancer, compared with $10,664 for beneficiaries without the cancers. However, only 9% to 30% of medical expenditures for dual eligibles with the study cancers were attributable to the cancer itself. In 2003, combined Medicare/Medicaid spending for dual eligibles attributable to the six cancers in the four study states exceeded $256 million ($314 million in 2012 dollars). Dual eligibles with these cancers also had high rates of other medical conditions. These comorbidities should be recognized, both in documenting cancer treatment costs and in developing programs and policies that promote timely cancer diagnosis and treatment.

Partial Text

Cancer is a leading cause of illness and death in the United States. In 2007, more than 1.4 million new cancer cases were diagnosed and almost 560,000 people died from cancer in the United States [1]. Annual U.S. expenditures for cancer treatment increased from $24.7 billion in 1987 to an average of $48.1 billion during 2001 to 2005 [2]. The burden of cancer care falls disproportionately on the Medicare program, which provides insurance to 15% of the U.S. population [3] but covers 34% of cancer treatment costs [2].

We analyzed merged 2003 Medicare and Medicaid Analytic eXtract file (MAX) enrollment and claims data for dually eligible beneficiaries in four states: Georgia, Illinois, Louisiana, and Maine. MAX is a uniform dataset containing Medicaid eligibility, utilization, and payment information that CMS creates from Medicaid Statistical Information System (MSIS) data submitted by all U.S. states. We analyzed 2003 data because it was the most recent year for which MAX data were available when our study began.

The final study population consisted of 892,001 dually eligible beneficiaries. Table 1 shows the age, race/ethnicity, sex, and state distribution of the study population in the four states by whether beneficiaries were diagnosed with any of the six study cancers. The comparison group includes both individuals without cancer and those with nonstudy cancers. However, less than 3% of beneficiaries in the comparison group had an invasive nonstudy cancer (Table 2). Beneficiaries with the six study cancers accounted for 62% of all beneficiaries with cancer in the study population (data not shown). Compared with beneficiaries in the comparison group, those with study cancers were older (mean age 75.1 years vs. 67.8 years), more likely to be white (67% vs. 64%), more likely to be male (38% vs. 34%), and less likely to have been enrolled for a full year (64% vs. 74%) (Table 1). Nearly half of all dually eligible beneficiaries in the study resided in Illinois, reflecting the larger size of that state’s population compared with the other study states.

In 2003, combined Medicare and Medicaid spending for dually eligible beneficiaries in the four study states attributable to the six study cancers was about $256 million, or 23% of total spending for these beneficiaries and 3% of spending for all dually eligible beneficiaries (excluding expenditures for prescription drugs and long-term care). In 2012 dollars, Medicare and Medicaid spending for the six cancers was about $314 million. Only 9% to 30% of medical expenditures for dually eligible beneficiaries with one the six types of cancers were attributable to the cancer itself. The relatively low proportion of expenditures attributable to the study cancers reflects the poor health status and high prevalence of comorbidities among dually eligible beneficiaries overall and especially among those with cancer. Dually eligible beneficiaries incurred substantial medical care costs for these comorbid conditions independent of their cancer status.





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