Chronic condition cost burden among older Medicare cancer patients.

Abstract

e23164 Background: With the rising comorbidity burden among cancer patients of older age, understanding the prevalence and added costs of chronic conditions within Medicare’s oncology population is required for value-based care management. Methods: We examined episode costs across seven cancer types using deidentified baseline episode files from Medicare’s Enhanced Oncology Model (EOM) (2016-2020). We first analyzed the prevalence of four common chronic conditions: morbid obesity, hypertension, endocrine disorders, and heart disease based on Hierarchical Condition Category for each cancer. Then we calculated trended winsorized standardized mean patient cost per episode for patients with these chronic conditions and compared with those without any of the four comorbidities as a reference group. Results: Hypertension has the highest prevalence of ~60%, followed by endocrine disorders (> 40%), heart disease (> 28%), and morbid obesity (~5%). Across all cancer types, patients with morbid obesity demonstrated the highest cost burden. Specifically the incremental costs ranged from $3,640 for small intestine/colorectal cancer to $8,194 for lymphoma, increasing 10–15% above the reference group. Heart disease is associated with a $4,600 increase in average cost for chronic leukemia, with a smaller increase seen in myeloma, but no meaningful impact in the other cancers. Prostate cancer patients with any of the four conditions had appreciably higher costs than their reference counterparts. Conclusions: Multiple chronic conditions in cancer patients increase the cost and complexity of oncology care. Specifically, addressing morbid obesity through prevention and tailored management may help reduce costs. Weight management and proactive management of comorbidities, along with integrated care models, may be essential to control costs and enhance outcomes in oncology. Prevalence (%) and patient trended winsorized standardized mean cost by cancer type. Referencegroup Hypertension Heart Disease Endocrine disorder Morbid Obesity Breast Cancer $48,355 (27.5) $47,068 (55.0) $49,358 (28.6) $48,142 (45.6) $54,590 (6.1) Chronic Leukemia $57,853 (18.2) $57,846 (62.3) $62,496 (43.1) $58,865 (49.9) $63,963 (5.6) Lung Cancer $64,667 (20.4) $64,932 (64.0) $64,363 (45.0) $65,353 (48.2) $69,926 (3.9) Lymphoma $55,386 (19.6) $55,337 (60.7) $56,929 (40.4) $56,204 (51.6) $63,580 (4.5) Multiple Myeloma $89,861 (19.4) $86,964 (61.9) $88,560 (40.8) $87,147 (49.5) $95,460 (4.9) Prostate Cancer $46,357 (19.5) $49,019 (65.9) $52,084 (42.7) $50,132 (42.4) $52,794 (4.3) Small Intestine / Colorectal Cancer $38,952 (27.6) $38,330 (59.2) $39,060 (33.6) $38,695 (42.0) $42,592 (5.5)