Differences among the elderly in the treatment costs of colorectal cancer: how important is race?

BACKGROUND: Medical expenditures adjusted for price differences are a barometer of total resources devoted to patient care and thus may reflect treatment differentials.
OBJECTIVE: We sought to estimate costs of the surgical and adjuvant treatment phases of colorectal cancer (CRC) care and cost differences by race (African American-white) and other patient characteristics.
METHODS: We used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database for stage II-III rectal and stage III colon cancer cases diagnosed in 1992-1996 to track Medicare approved payments for fee-for-service beneficiaries 66 and older in surgical (within 3 months of diagnosis) and postsurgical phases (13 months after the surgical phase). Net costs adjusted for expected noncancer expenditures were estimated with generalized linear models using pooled CRC and non-CRC cohorts. Using model results, we projected adjusted net costs for different patient groups (eg, by race, age).
RESULTS: Total unstandardized CRC costs for African American recipients were $44,199, a statistically significant 15% higher than for white recipients ($38,378). Adjusting for covariates and expected non-CRC costs decreased the estimate for African American recipients to $34,588, a statistically insignificant $974 (2.9%) more than white recipients. Differential expenditures by age, urban-rural setting, region, and neighborhood median income were all much larger than differences by race, although only region was statistically significant.
CONCLUSIONS: African American CRC patients cost more than their white counterparts, but adjusted differences were nonsignificant and trivial. Several nonracial cost differences were considerably larger (but not all statistically significant), and suggest that future research pay more attention to these characteristics.