Analyses of Cancer Prevalence and Healthcare Costs for Metastatic and Non-Metastatic Cancers Among Employees Using Claims Data

OBJECTIVES: Cancer diagnoses after metastasis represent a substantial fraction of the total costs of healthcare for employed individuals over the age of 50. This study seeks to explore the prevalence and relative costs of metastatic and non-metastatic cancers among employed individuals.

METHODS: A retrospective claims analysis was conducted using the IQVIA PharMetrics Plus dataset. The analyses focused on real-world healthcare costs of enrollees aged 50-64 with claims for either metastatic or non-metastatic cancers in 2022. Cancer claims were identified using ICD-10-CM codes based on either one inpatient or two outpatient claims. Metastatic cancers were identified using the presence of either a claim for a secondary cancer or cancers at two anatomic locations at initial diagnosis. To understand the impact of diagnosis after metastasis, the analysis compared paid amounts for individuals with metastatic versus non-metastatic cancers matched by cancer type, stratified by sex and 5-year age groups.

RESULTS: The prevalence of individuals being treated for metastatic and non-metastatic cancer increased with age from 0.69% and 1.28%, respectively, from ages 50 to 54 to 1.41% and 2.68% from ages 60 to 64. In the overall age range of 50-64, 34% of individuals with metastatic claims had costs exceeding $100k in a one-year period, while only 13% of those with non-metastatic claims exceeded the same threshold. Correspondingly, the average cost for each individual with a metastatic cancer claim was $90,336, while the average cost for non-metastatic claims, weighted to the same cancer type distribution, was $30,051. Accounting for prevalence of metastatic cancer, spending on metastatic versus non-metastatic cancer of the same type represented a potential difference of $625 per enrollee between ages 50 and 64.

CONCLUSIONS: Spending on cancer care among employees 50 to 64 years of age may be substantially reduced if cancers currently diagnosed after metastasis could be found when non-metastatic.