IMPACT OF EMERGENCY DEPARTMENT (ED) INVOLVEMENT AT CANCER DIAGNOSIS ON HEALTHCARE COSTS (HCC) ACROSS CANCER TYPES IN THE MEDICARE POPULATION
Author(s)
Shannon Heitkamp, MS1, Eric B. Olsen, MD2, Ali Tafazzoli, PhD3, Bethany Houpt, MPH1, Olivia Hunt, MM1, Anuraag R. Kansal, PhD3, A Mark Fendrick, MD4, Eric Klein, MD3;
1Avalere Health, Washington, DC, USA, 2UCHealth Poudre Valley Hospital, Fort Collins, CO, USA, 3GRAIL, Inc., Menlo Park, CA, USA, 4University of Michigan, Ann Arbor, MI, USA
1Avalere Health, Washington, DC, USA, 2UCHealth Poudre Valley Hospital, Fort Collins, CO, USA, 3GRAIL, Inc., Menlo Park, CA, USA, 4University of Michigan, Ann Arbor, MI, USA
OBJECTIVES: A substantial proportion of cancers are diagnosed following ED involvement, a pathway associated with poorer clinical outcomes and potentially higher healthcare burden. This study aimed to quantify HCC associated with ED involvement at cancer diagnosis among Medicare beneficiaries across a broad range of cancer types.
METHODS: We conducted a retrospective cohort analysis using SEER-Medicare data for beneficiaries diagnosed with invasive cancer from 2010-2020. The index date was the earliest cancer-related claim, with ED involvement defined as an ED visit within 30 days before that date. We examined cancer-related HCC (inpatient, outpatient, and pharmacy) in the year following diagnosis for 17 cancer types. Expenditures were modeled for each cancer type, adjusting for age, sex, race/ethnicity, dual eligibility, Charlson Comorbidity Index, cancer site, year of diagnosis, and cancer stage. This analysis did not adjust for unmeasured confounders such as symptom duration, performance status, or access to and timing of therapy.
RESULTS: Among 818,120 study population with newly diagnosed cancer (mean age 74.4 years), 26.4% had ED involvement, accounting for 62% of the total cancer-specific HCC in the year following diagnosis. In the adjusted analyses, patients diagnosed with ED involvement incurred substantially higher all-cause and cancer-specific HCC in the first year post diagnosis compared with those diagnosed through non-ED routes (mean adjusted total cancer-related HCC: $167,581 vs $61,177 per patient-year; SD: $69,261 for both). HCC were higher for patients with ED involvement in all cancer types studied. The estimated difference in first-year cancer-specific HCC ranged from $32,641 per patient (ED involvement vs non-ED) for prostate cancer to $270,472 for leukemia.
CONCLUSIONS: ED involvement at cancer diagnosis is associated with substantially greater Medicare expenditures across cancer types, suggesting strategies to reduce emergency-driven cancer detection may significantly reduce the economic burden of cancer.
METHODS: We conducted a retrospective cohort analysis using SEER-Medicare data for beneficiaries diagnosed with invasive cancer from 2010-2020. The index date was the earliest cancer-related claim, with ED involvement defined as an ED visit within 30 days before that date. We examined cancer-related HCC (inpatient, outpatient, and pharmacy) in the year following diagnosis for 17 cancer types. Expenditures were modeled for each cancer type, adjusting for age, sex, race/ethnicity, dual eligibility, Charlson Comorbidity Index, cancer site, year of diagnosis, and cancer stage. This analysis did not adjust for unmeasured confounders such as symptom duration, performance status, or access to and timing of therapy.
RESULTS: Among 818,120 study population with newly diagnosed cancer (mean age 74.4 years), 26.4% had ED involvement, accounting for 62% of the total cancer-specific HCC in the year following diagnosis. In the adjusted analyses, patients diagnosed with ED involvement incurred substantially higher all-cause and cancer-specific HCC in the first year post diagnosis compared with those diagnosed through non-ED routes (mean adjusted total cancer-related HCC: $167,581 vs $61,177 per patient-year; SD: $69,261 for both). HCC were higher for patients with ED involvement in all cancer types studied. The estimated difference in first-year cancer-specific HCC ranged from $32,641 per patient (ED involvement vs non-ED) for prostate cancer to $270,472 for leukemia.
CONCLUSIONS: ED involvement at cancer diagnosis is associated with substantially greater Medicare expenditures across cancer types, suggesting strategies to reduce emergency-driven cancer detection may significantly reduce the economic burden of cancer.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE249
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology