Breast cancer is associated with higher health care use and costs for women covered by fee-for-service MedicaidIn addition to being the most frequently diagnosed cancer among women in the United States, breast cancer accounts for up to 20 percent of the total costs of cancer overall. Women covered by Medicaid have unique challenges when it comes to this disease. For example, Medicaid recipients are more likely to be diagnosed at an advanced stage. They also have much lower screening rates compared to the general population. A new study found a high prevalence of breast cancer in Medicaid patients as well as significantly higher health care use and costs.
The study was based on administrative claims data for fee-for-service recipients enrolled in West Virginia Medicaid. A total of 876 Medicaid recipients, 21 to 64 years of age and who had breast cancer-related treatment, were identified during 2005. Nearly half were between the ages of 50 and 59. Prevalence rates for breast cancer were highest for women 60 to 64 years of age, white women, and women residing in rural counties. These three groups also had the highest rates of office visits. Older and rural groups also had the highest rates of emergency room (ER) visits and cancer-related hospitalizations. Nearly three-fourths (73 percent) of the women had at least one claim for treatment. The vast majority of treatment services (98 percent) were delivered in the office setting. Hormone therapy was the most common form of treatment, with more than half (55.1 percent) of women receiving it.
Women with breast cancer were compared to a matched control group of female Medicaid recipients without breast cancer. Health care costs for all causes were significantly higher for the women with breast cancer ($16,345) compared with the women without breast cancer ($13,027). These additional costs were driven by expenses for office and ER visits as well as for prescription medications. The West Virginia Medicaid fee-for-service program paid approximately $4.9 million for breast cancer-related treatment and services in 2005. The study was supported in part by the Agency for Healthcare Research and Quality (HS18546).
See "Prevalence, healthcare utilization, and costs of breast cancer in a state Medicaid fee-for-service program," by Rahul Khanna, M.B.A., Ph.D., S. Suresh Madhavan, M.B.A., Ph.D., Abhijeet Bhanegaonkar, M.P.H., and Scott C. Remick, M.D., in the Journal of Women's Health 20(5), pp. 739-747, 2011.