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Journal of Clinical Oncology, Vol 25, No 28 (October 1), 2007: pp. 4501-4502 © 2007 American Society of Clinical Oncology. DOI: 10.1200/JCO.2007.13.1243
Age Group–Specific Gap Between Treatment Cost of and Mortality Due to Breast and Colorectal CancerDepartment of Health Economics, Policy & Management, University of Pécs, Pécs, Hungary
County Baranya Health Insurance Fund Administration, National Health Insurance Fund Administration, Pécs, Hungary
Second Department of Medicine, University of Pécs, Pécs, Hungary
Institute of Nursing and Clinical Sciences, University of Pécs, Pécs, Hungary
Department of Oncotherapy, University of Pécs, Pécs, Hungary
Institute of Nursing and Clinical Sciences, University of Pécs; and theDepartment of Obstetrics and Gynecology, Baranya County Teaching Hospital of Pécs, Pécs, Hungary To the Editor: We read with great interest the articles by Sanoff et al1 and Crivellari et al2 on the treatment of older patients with breast and colorectal cancer. Both articles review the special needs of elderly population during cancer treatment. In a country like Hungary, where health care resources are more limited, the efficiency and equity problems of health care are more important. We analyzed the annual (2001), nationwide treatment cost distribution of breast3 and colorectal4 cancer. We compared the annual out- and inpatient care treatment cost of and the annual number of deaths due to breast and colorectal cancer according to age groups. Data were extracted from the nationwide the database of the National Health Insurance Fund Administration (OEP), the only health care financing agency in Hungary, containing routinely collected financial data. Compared with Medicare claims data, the Hungarian OEP's database covers the whole country and all age groups, not only those older 65 years of age.5 We found that women age birth to 64 accounted for 42% of all deaths due to breast cancer and they received 72% of the health insurance expenditures for in- and outpatient care treatment of breast cancer. In contrast, women older than 65 accounted for 58% of all deaths due to breast cancer and received only 28% of treatment cost. In case of colorectal cancer, 26% of all deaths due to colorectal cancer occurred in people from birth to 64 years, while they consumed 41% to 43% of treatment cost. People older than 65 account for 74% of deaths due to colorectal cancer and received only 57% to 59% of all of the treatment cost (Fig 1).
Taking into consideration even the natural course of these diseases, there is a shift between the distribution of treatment cost of and deaths due to breast and colorectal cancer in favor of younger age groups. Max et al reported a similar finding in cervical cancer, where almost two thirds (64%) of the deaths due to cervical cancer occurred among women younger than 65, while they represent 84.2% of hospital costs. Most of these differences are derived from the different preferences in treatment, and the undertreatment of senior patients older than 65 years resulted in a higher breast cancer mortality.6 Our study also confirmed that older colorectal cancer patients are less likely to receive treatment.7 Although the undertreatment of elderly population can be explained partly by the general health status of senior people, it is a major challenge for oncologists to balance the risks and benefits of treatment in elderly patients on an individual level. Health care financing agencies face the same challenge in providing equal access to treatment for elderly patients on a population level. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest.
REFERENCES
1. Sanoff HK, Bleiberg H, Goldberg RM: Managing older patients with colorectal cancer. J Clin Oncol 25:1891-1897, 2007 2. Crivellari D, Aapro M, Leonard R, et al: Breast cancer in the elderly. J Clin Oncol 25:1882-1890, 2007 3. Boncz I, Sebestyén A, Döbr 4. Boncz I, Palasti J, Betlehem J, et al: The annual health insurance cost of colorectal cancer treatment in Hungary: A cost of illness study. Value Health 9:A108, 2006 (abstr) 5. Du XL, Goodwin JS: Patterns of use of chemotherapy for breast cancer in older women: Findings from Medicare claims data. J Clin Oncol 19:1455-1461, 2001 6. Bouchardy C, Rapiti E, Gerald F, et al: Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 21:3580-3587, 2003 7. Lemmens VE, van Halteren AH, Janssen-Heijnen ML, et al: Adjuvant treatment for elderly patients with stage III colon cancer in the southern Netherlands is affected by socioeconomic status, gender, and comorbidity. Ann Oncol 16:767-772, 2005 Related Reply
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Copyright © 2007 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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ssy L, et al: Gap between inpatient treatment cost of and mortality due to breast cancer in Hungary. Value Health 10:A135, 2007 (abstr)
