Regional Medicare Expenditures and Survival Among Older Women With Localized Breast Cancer

Med Care. 2017 Dec;55(12):1030-1038. doi: 10.1097/MLR.0000000000000822.

Abstract

Background: Despite evidence on large variation in breast cancer expenditures across geographic regions, there is little understanding about the association between expenditures and patient outcomes.

Objectives: To examine whether Medicare beneficiaries with nonmetastatic breast cancer living in regions with higher cancer-related expenditures had better survival.

Research design: A retrospective cohort study of women with localized breast cancer from the Surveillance, Epidemiology, and End Results-Medicare linked database. Hospital referral regions (HRR) were categorized into quintiles based on risk-standardized per patient Medicare expenditures on initial phase of breast cancer care. Hierarchical generalized linear models were estimated to examine the association between patients' HRR quintile and survival.

Subjects: In total, 12,610 Medicare beneficiaries diagnosed with stage II-III breast cancer during 2005-2008 who underwent surgery.

Measures: Outcome measures for our analysis were 3- and 5-year overall survival.

Results: Risk-standardized per patient Medicare expenditures on initial phase of breast cancer care ranged from $13,338 to $26,831 across the HRRs. Unadjusted 3- and 5-year survival varied from 66.7% to 92.2% and 50.0% to 84.0%, respectively, across the HRRs, but there was no significant association between HRR quintile and survival in bivariate analysis (P=0.08 and 0.28, respectively). After adjustment for sociodemographic and clinical characteristics, quintiles of regional cancer expenditures remained unassociated with patients' 3-year (P=0.35) and 5-year survival (P=0.20). Further analysis adjusting for treatment factors (surgery type and receipt of radiation and systemic therapy) and stratifying by cancer stage showed similar results.

Conclusions: For Medicare beneficiaries with nonmetastatic breast cancer, residence in regions with higher breast cancer-related expenditures was not associated with better survival. More attention to value in breast cancer care is warranted.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / economics*
  • Breast Neoplasms / epidemiology
  • Cohort Studies
  • Female
  • Health Expenditures / statistics & numerical data*
  • Hospital Planning / economics*
  • Humans
  • Medicare / statistics & numerical data*
  • Neoplasm Staging
  • Referral and Consultation / statistics & numerical data
  • Residence Characteristics
  • Retrospective Studies
  • Socioeconomic Factors
  • United States