Prevalence and cost of cancer care in the military health system, FY2006 – FY2013

Objective Cancer is one of the most costly illnesses for health care systems, including the Department of Defense (DoD) Military Health System. Here, we examine the prevalence and costs of cancer care over a 8-year period examining differences by health care systems, and location of care. Study Design Primary ICD-9 codes for cancer diagnoses were obtained from the Military Health System's Master Data Repository for claims paid by TRICARE in fiscal years 2006 - 2013. Cancer diagnoses were assessed together and by cancer type, for certain cancers of interest. Trend analyses were used to examine the number of unique beneficiaries with a cancer diagnosis, and variation in costs by ambulatory or inpatient care. Costs of cancer were initially developed at an aggregated level, excluding pharmacy; subsequent analyses identified specific cancers of interest, and included cancer-specific pharmacy costs. Population Studied All adult MHS beneficiaries 18 – 64 years of age, residing within the United States for Fiscal Years 2006-2013 were included if they had 2 visits and/or 1 inpatient stay with a primary diagnosis of cancer. Beneficiaries were included only if they had accessed the healthcare system within the given fiscal year. Principal Findings The number of unique DoD beneficiaries with a cancer diagnosis was about 367,200 in FY2006 compared to around 465,500 in FY2010, representing a 27% increase in 5 years. Over the same period, costs increased 14%, from $795.6 million in FY2006 to $906.9 million in FY2010. Steady increases in cost were observed until FY2009 when the annual cost change slowed to 1%. The costs for civilian care delivered in ambulatory setting increased from FY2006 to FY2009, then decreased 1.2% between FY2009 and FY2010. In the military health care system ambulatory costs increased until FY2009 then decreased 1.3% while inpatient costs increase 5% between FY2009 and FY2010. Cancer-specific data are forth-coming. Conclusions While an increase in cancer prevalence was expected given the growing population of DoD beneficiaries and improved cancer survival, the slowing of annual cost change between FY2009 and FY2010 was unexpected, as were the changes observed in ambulatory/inpatient costs. Further analysis is needed to examine the subpopulation of cancer patients who received chemotherapy as part of their initial cancer treatment, and to examine justification for hospitalizations. Implications for Policy or Practice DoD's adoptation of Medicare policies for reimbursement of cancer care appears to impact DoD costs and location of cancer care for non-elderly adults.