Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Xiaomei Ma

Abstract

Objectives: 1) To review costs of prostate cancer care in multiple countries 2) To summarize studies assessing regional variation in costs of prostate cancer care within the United States 3) To characterize variation across hospital referral regions (HRRs) in Medicare expenditures on initial prostate cancer care and evaluate its determinants. Methods: A thorough literature search was conducted to identify the costs of prostate cancer care in different countries and within the United States (to assess regional variation in costs). Subsequently, the thesis involved an in-depth use of the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database and the Medicare 5% random sample of non-cancer beneficiaries in the SEER-17 regions. Each man identified with first primary localized prostate cancer was matched to a man without cancer based on age, race, comorbidity and date of diagnosis. We estimated Medicare expenditure on prostate cancer-related care by calculating the incremental expenditure between cancer patients and the controls during the initial phase of care. Hierarchical generalized linear models were used for risk adjustment. Results: Total Medicare expenditure on prostate cancer-related care averaged $15,567 per patient. HRRs in the highest quintile had an average expenditure of $19,236 per patient, which was $6,664 (or 53%) higher than HRRs in the lowest quintile (i.e., $12,572). There was also large variation in radiation therapy costs, with average expenditures ranging from $7,948 to $13,522 in the lowest and highest spending quintiles, respectively. Patient demographic, clinical, and treatment factors explained 19% of the variation in total cancer-related expenditure across the HRR quintiles. Conclusions: There are few cost studies that study geographic variation in costs of prostate cancer care. They conclude that there is variation in costs of prostate cancer care between countries. The analysis conducted for the United States shows substantial regional variation in Medicare expenditures on initial prostate cancer care. Patient demographic and clinical characteristics did not explain this variation, while the use of active treatment versus watchful waiting and the utilization of specific treatment strategies explained a relatively small percentage of the variation.

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This is an Open Access Thesis.

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