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Cost of Breast Cancer Treatment in Medicaid: Implications for State Programs Providing Coverage for Low-Income Women

Subramanian, Sujha PhD*; Trogdon, Justin PhD*; Ekwueme, Donatus U. PhD†; Gardner, James G. MPH†; Whitmire, J. Timothy PhD‡; Rao, Chandrika PhD‡

doi: 10.1097/MLR.0b013e3181f81c32
Original Article

Background: To date, no study has reported on the cost of treating breast cancer among Medicaid beneficiaries younger than 65 years of age. This information is essential for assessing the funding required for treatment programs established by the Breast and Cervical Cancer Prevention and Treatment Act of 2000.

Objective: This study assesses the incremental cost of breast cancer treatment among Medicaid beneficiaries aged below 65 years.

Research Design: Administrative data from the North Carolina Medicaid program linked with cancer registry data were analyzed to derive monthly Medicaid costs for cancer patients and the incremental costs of breast cancer treatment at 6, 12, and 24 months from diagnosis. We compared 848 beneficiaries diagnosed with cancer during the years 2002 to 2004 with 1696 comparison cases matched on age.

Results: With the exception of in situ cancers, the cost of cancer care continued to increase beyond the initial 6-month period. The incremental costs at 6 months after diagnosis are $14,341, $24,002, and $34,469 for those with local, regional, and distant breast cancers, respectively; and these costs increased to $22,343, $41,005, and $117,033 at 24 months.

Conclusions: The extended period of health care utilization, beyond the immediate 6-month period after diagnosis, indicates that Medicaid coverage may be required for many months after diagnosis to complete treatment. Continuous Medicaid coverage should be provided for an adequate time period to ensure that complete and comprehensive treatment is provided.

From the *RTI International, Waltham, MA; †Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and ‡State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC.

Supported (in part) by Contract No. 200–2002–00575 TO 06 from the Centers for Disease Control and Prevention (CDC).

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Reprints: Sujha Subramanian, PhD, Research Triangle Institute, 1440 Main St, Suite 310, Waltham, MA 02451. E-mail: ssubramanian@rti.org.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.lww-medicalcare.com).

© 2011 Lippincott Williams & Wilkins, Inc.