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Policy and Cost Implications of VA and Medicare Dual Use for Colon Cancer Care

Hynes DM, Tarlov E, Lee TA, Weichle TW, Durazo-Arvizu R, Perrin RA, Zhang Q, Ferreira M, Bennett CL. Policy and Cost Implications of VA and Medicare Dual Use for Colon Cancer Care. Paper presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL.


Research Objective: To examine and compare healthcare use and costs for colon cancer patients treated in the Veterans Health Administration (VA) and Medicare Study Design: This study linked clinical data from eight National Cancer Institute Surveillance and Epidemiology and End Results (SEER) Programs with VA and Medicare workload and claims data for a retrospective cohort of colon cancer patients who were at least 66 years old and eligible to use both VA and Medicare healthcare between 1999 and 2003. We characterized and compared healthcare use and costs in terms of patient demographics, prior health care use, clinical characteristics and geographic factors. We examined healthcare use and costs in the VA and Medicare for the twelve month period following colon cancer diagnosis and compared diagnosis setting (VA vs. Medicare) and use of both VA and Medicare for treatment of colon cancer (CC Dual Users). All costs were adjusted to 2004 dollars. Population Studied: Elderly veterans with colon cancer eligible to use both VA and Medicare healthcare Principal Findings: Among the 1,962 veterans identified with colon cancer, 95% were male; 14% were African American; 21% were diagnosed at a VA facility; 38.9% received any services in both VA and Medicare settings and 12% were CC Dual Users. Mean twelve month costs were similar for CC Dual Users diagnosed under Medicare, non-CC Dual users diagnosed under Medicare, and non-CC Dual Users diagnosed in VA ($45,010 vs. $45,599 vs. $44,908 respectively); however costs were significantly higher for patients diagnosed at the VA who were CC Dual Users ($67,520). Multivariable regression analyses showed that after adjustment for differences in demographics, stage at diagnosis, colon cancer surgery, comorbidity score, geographic factors, and prior health care use, healthcare costs were 37% higher among VA diagnosed CC Dual Users than veterans who were diagnosed in a Medicare setting and treated for their colon cancer exclusively under Medicare (non-CC Dual Users) (Incident Rate Ratio (IRR) 1.37; 95% CI 1.07-1.75). In contrast, for veterans who were diagnosed in the Medicare setting and were CC Dual Users, total costs were 12% lower compared to veterans who were diagnosed and treated exclusively under Medicare (IRR 0.88. ; 95%CI: 0.79-0.98). Conclusions: Veterans who are dual users of VA and Medicare services for colon cancer care experience significantly different overall healthcare costs depending in part on where they begin their cancer care. Differences in the course of treatment, quality of care and costs attributable to colon cancer warrants further study. Implications for Policy, Delivery or Practice: The differential increase on healthcare costs for those colon cancer patients diagnosed in the VA and using both VA and Medicare for treatment of their colon cancer is important to understand as policymakers consider new health coverage benefits aimed at improving efficiency and quality of care across and within VA and Medicare programs. Whether these cost differences translate into differences in quality of cancer care deserves urgent attention.

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