Kelly M Kenzik1, Grant R Williams2, Nickhill Bhakta3, Leslie L Robison4, Wendy Landier5, Gaurav Goyal6, Amitkumar Mehta6, Smita Bhatia5. 1. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, USA. Electronic address: kkenzik@uab.edu. 2. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, USA. 3. Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA. 4. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA. 5. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Pediatric Oncology, University of Alabama at Birmingham, USA. 6. Division of Hematology and Oncology, University of Alabama at Birmingham, USA.
Abstract
BACKGROUND: Developing appropriate care models for patients diagnosed with non-Hodgkin lymphoma (NHL) >65y require examination of current healthcare utilization patterns and cost, but non-malignant condition-specific utilization and Medicare spending among older patients has not been characterized. METHODS: Using SEER-Medicare, 14,533 patients diagnosed with NHL at age > 65 between 2008 and 2015 and a comparable non-cancer cohort (n = 14,533) were identified. Hospitalizations and outpatient visits for 109 non-malignant conditions were grouped into ten categories, allowing condition-specific utilization and spending calculation from diagnosis to 5y, censoring at blood or marrow transplantation, 6mo prior to death or end (12/31/2016). Using the 90th percentile as a cut-off, factors associated with high-hospitalization rates and high-spending were evaluated. RESULTS: Patients with NHL were 1.5-fold more likely to be hospitalized and 1.8-fold more likely to experience outpatient visits when compared with the non-cancer cohort. Patients with NHL had greater aging-related, cardiovascular, and gastrointestinal hospitalizations than controls (p < 0.001). Average Medicare spending/visit was higher for patients with NHL (hospitalization: $16,950 vs. $13,474, p < 0.001; outpatient: $1176 vs. $392, p < 0.001). Factors associated with high-utilization and high-spending included diffuse large B cell lymphoma subtype, non-white race, and residence in low-education area. CONCLUSIONS: Older patients with NHL experienced higher utilization and higher spending per-utilization compared to a non-cancer cohort over five years from cancer diagnosis. Clinical and demographic sub-groups demonstrated increased risk for the highest spending and utilization. The substantial utilization and spending for non-malignant conditions among older patients with NHL provides quantifiable evidence for survivor-adapted healthcare management policies.
BACKGROUND: Developing appropriate care models for patients diagnosed with non-Hodgkin lymphoma (NHL) >65y require examination of current healthcare utilization patterns and cost, but non-malignant condition-specific utilization and Medicare spending among older patients has not been characterized. METHODS: Using SEER-Medicare, 14,533 patients diagnosed with NHL at age > 65 between 2008 and 2015 and a comparable non-cancer cohort (n = 14,533) were identified. Hospitalizations and outpatient visits for 109 non-malignant conditions were grouped into ten categories, allowing condition-specific utilization and spending calculation from diagnosis to 5y, censoring at blood or marrow transplantation, 6mo prior to death or end (12/31/2016). Using the 90th percentile as a cut-off, factors associated with high-hospitalization rates and high-spending were evaluated. RESULTS: Patients with NHL were 1.5-fold more likely to be hospitalized and 1.8-fold more likely to experience outpatient visits when compared with the non-cancer cohort. Patients with NHL had greater aging-related, cardiovascular, and gastrointestinal hospitalizations than controls (p < 0.001). Average Medicare spending/visit was higher for patients with NHL (hospitalization: $16,950 vs. $13,474, p < 0.001; outpatient: $1176 vs. $392, p < 0.001). Factors associated with high-utilization and high-spending included diffuse large B cell lymphoma subtype, non-white race, and residence in low-education area. CONCLUSIONS: Older patients with NHL experienced higher utilization and higher spending per-utilization compared to a non-cancer cohort over five years from cancer diagnosis. Clinical and demographic sub-groups demonstrated increased risk for the highest spending and utilization. The substantial utilization and spending for non-malignant conditions among older patients with NHL provides quantifiable evidence for survivor-adapted healthcare management policies.
Authors: Rahul Garg; Usha Sambamoorthi; Xi Tan; Soumit K Basu; Treah Haggerty; Kimberly M Kelly Journal: Transl Behav Med Date: 2018-05-23 Impact factor: 3.046
Authors: Sujha Subramanian; Florence K L Tangka; Susan A Sabatino; David Howard; Lisa C Richardson; Susan Haber; Michael T Halpern; Sonja Hoover Journal: Medicare Medicaid Res Rev Date: 2013-01-17
Authors: Claire F Snyder; Kevin D Frick; Robert J Herbert; Amanda L Blackford; Bridget A Neville; Antonio C Wolff; Michael A Carducci; Craig C Earle Journal: J Clin Oncol Date: 2013-02-11 Impact factor: 44.544
Authors: Shuling Li; Jiannong Liu; Charles Bowers; Tamer A F S Garawin; Christopher Kim; Mark E Bensink; David B Chandler Journal: Support Care Cancer Date: 2019-04-15 Impact factor: 3.603
Authors: Alan S Go; Jingrong Yang; Thida C Tan; Claudia S Cabrera; Bergur V Stefansson; Peter J Greasley; Juan D Ordonez Journal: BMC Nephrol Date: 2018-06-22 Impact factor: 2.388
Authors: Laura Deckx; Marjan van den Akker; Job Metsemakers; André Knottnerus; François Schellevis; Frank Buntinx Journal: J Cancer Epidemiol Date: 2012-08-23