218563 Medicaid expenditures for cancer prevention and treatment: Evidence from four states

Monday, November 8, 2010

Florence K.L. Tangka, PhD , Division of Cancer Prevention and Control, CDC, Chamblee, GA
Susan Haber, ScD , RTI International, Waltham, MA
Lisa Richardson, MD , National Center for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, CSB, Centers for Disease Control and Prevention (CDC), Atlanta, GA
Susan Sabatino, MD , Division of Cancer Prevention and Control, CDC, Chamblee, GA
David H. Howard, PhD , Department of Health Policy and Management, Emory University, Atlanta, GA
Suhja Subramanian, PhD , RTI International, Waltham, MA
Sonja Hoover, MPP , RTI International, Waltham, MA
This study uses 2000-2003 Medicaid data to quantify Medicaid expenditures for treating six cancers (breast, cervical, colorectal, lung, melanoma, and prostate). We also tabulate expenditures for screening and diagnostic testing for breast, cervical, colorectal, and prostate cancer. The study population includes Medicaid beneficiaries age>18 who are not dually eligible for Medicare in Georgia (n=683,695), Illinois (n=953,556), Louisiana (n=375,851), and Maine (n=194,425). We used multivariate regression to estimate marginal expenditures attributable to each cancer after controlling for sociodemographics and comorbid conditions. Breast cancer was the most prevalent cancer in all four states (about 7/1,000), followed by lung, colorectal, cervical, prostate, and melanoma. Compared to those without cancer, Medicaid beneficiaries with cancer were significantly older, more likely to be white and male, and more likely to have a variety of comorbidities, including diabetes, hypertension and other cardiovascular diseases. Depending on the state and cancer site, unadjusted Medicaid expenditures were 3-8 times higher for Medicaid beneficiaries with cancer compared to those without cancer. However, only a portion of these expenditures were attributable to cancer, about 10-50% depending on the state and cancer. Regression-adjusted Medicaid expenditures attributable to the six cancers ranged from $29 million in Maine to $84 million in Georgia. During a four-year period, about 55% of age- and sex-eligible Medicaid beneficiaries were tested for cervical cancer, about 40% for breast, about 15-40% for prostate (depending on the state), and 20-25% for colorectal. Expenditures for cancer screening and diagnostic testing were 30-60% of expenditures for cervical, breast, colorectal, and prostate cancer treatment.

Learning Areas:
Biostatistics, economics
Chronic disease management and prevention

Learning Objectives:
1. Differentiate between total expenditures for people with cancer and the portion of their expenditures attributable to cancer. 2. Describe the econometric method for estimating expenditures attributable to cancer. 3. Compare Medicaid expenditures for cancer treatment to expenditures for cancer screening and diagnostic testing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Because I proposed the study and contribute scientifically to the analysis and write-up.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.