Patterns of Medical Care Cost by Service Type for Patients With Recurrent and De Novo Advanced Cancer

Published:September 20, 2021DOI:


      • Understanding cost patterns for patients with advanced cancer is valuable for assessing the economic burden of disease and program planning and as inputs in cost-effectiveness, simulation studies and payment models that rely on empirical data.
      • Findings from our study of 7112 patients who received a diagnosis of de novo stage IV and recurrent breast, colorectal, and lung cancer between 2000 and 2012 provide new insight into the heterogeneity in direct medical costs, underscoring distinct cost patterns for patients receiving diagnosis of a recurrence <1 year after their initial cancer diagnosis compared with those with a recurrence in 1 year or longer after initial diagnosis and those with de novo stage IV disease.
      • Estimates of medical care costs among patients with advanced cancer that do not account for recurrence and timing of recurrence compared with initial diagnosis may not reflect the true variation in resources required to care for these patients.



      There is limited knowledge about the cost patterns of patients who receive a diagnosis of de novo and recurrent advanced cancers in the United States.


      Data on patients who received a diagnosis of de novo stage IV or recurrent breast, colorectal, or lung cancer between 2000 and 2012 from 3 integrated health systems were used to estimate average annual costs for total, ambulatory, inpatient, medication, and other services during (1) 12 months preceding de novo or recurrent diagnosis (preindex) and (2) diagnosis month through 11 months after (postindex), from the payer perspective. Generalized linear regression models estimated costs adjusting for patient and clinical factors.


      Patients who developed a recurrence <1 year after their initial cancer diagnosis had significantly higher total costs in the preindex period than those with recurrence ≥1 year after initial diagnosis and those with de novo stage IV disease across all cancers (all P < .05). Patients with de novo stage IV breast and colorectal cancer had significantly higher total costs in the postindex period than patients with cancer recurrent in <1 year and ≥1 year (all P < .05), respectively. Patients in de novo stage IV and those with recurrence in ≥1 year experienced significantly higher postindex costs than the preindex period (all P < .001).


      Our findings reveal distinct cost patterns between patients with de novo stage IV, recurrent <1-year, and recurrent ≥1-year cancer, suggesting unique care trajectories that may influence resource use and planning. Future cost studies among patients with advanced cancer should account for de novo versus recurrent diagnoses and timing of recurrence to obtain estimates that accurately reflect these care pattern complexities.


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