Miriam E. Tucker

April 24, 2013

CHICAGO — Differentiated thyroid cancer (DTC) is associated with significant economic burden in the elderly, and the largest drivers of cost are older age and increased number of comorbidities, a new Medicare analysis has shown.

The findings were presented by Melissa M. Boltz, DO, at the American Association of Endocrine Surgeons 2013 Annual Meeting last week.

The results indicate that "this patient population should be treated sooner rather than later," said Dr. Boltz, from the Milton S. Hershey Medical Center, Pennsylvania State University, Hershey.

Session moderator Rebecca S. Sippel, MD, chief of endocrine surgery at the University of Wisconsin, Madison, agreed. She told Medscape Medical News: "The sooner we intervene, the better… The life expectancy of someone age 65 is 20 years, so to say we shouldn't intervene in someone that age is wrong."

Stepwise Increment in Costs With Advancing Disease

Thyroid-cancer incidence in the United States has doubled since 1970, with a total of 56,460 cases diagnosed in 2012. In the elderly, DTC is often more aggressive, with larger tumors, extensive local growth, and distant metastases. While long-term survival is common, little is known about the costs of the follow-up and treatment that continue years beyond the surgical procedure.

Also, treatment and surveillance guidelines "do not differentiate between age groupings in their recommendations." Dr. Boltz told Medscape Medical News.

She reported data on 2823 patients aged 66 years and older diagnosed with primary DTC during 1995–2005, which were obtained from the Surveillance Epidemiology and End Results (SEER)–Medicare database. Those patients were matched for age and other demographic factors with 5646 noncancer cases. Cumulative costs at 1 and 5 years were estimated with adjustment for inflation to 2009 dollars.

As expected, the most significant costs attributed to thyroid cancer occurred immediately following diagnosis, averaging $7000 to $11,000 within the first 7 months. The costs leveled out at about 10 months and remained stable through 5 years.

At 1 year, the DTC cases averaged cumulative costs of $30,000 compared with just $10,000 for the noncancer comparison group. By 5 years, those figured had grown to $66,000 vs $43,500, with a difference of $22,500 directly attributable to DTC, Dr. Boltz said.

Stage of disease made a major difference to costs, with a 5-year figure of $21,264 for distant metastases vs just $8902 for regional disease (P < .05).

"As might be expected due to higher disease burden, patients with more advanced disease had a stepwise increment in costs associated with thyroid-cancer care," she observed.

Earlier Intervention Better, on All Counts

Comorbidities also contributed to costs, at $62,234 for patients with 3 or more comorbidities compared with $27,648 for those with just 1 or 2 (P < .05).

And although treatment involving surgery and radiation increased costs by $690 at 1 year, treatment costs compared with the noncancer patients had actually dropped by $722 by 5 years among the patients who received the combination treatment.

"The addition of multimodal treatment for DTC is often the standard pathway for the care of these patients. While this has been shown to offer decreases in disease recurrence, it does come with an associated economic cost," Dr. Boltz explained. "However, the use of radioisotope therapy in an adjuvant setting increases the 1-year costs only by $700 and, interestingly, decreases 5-year costs by an average of $700," she added.

Dr. Sippel told Medscape, "We only get older and sicker… I think the earlier we intervene, the less expensive it's going to be and the better their outcomes will be."

Neither Dr. Boltz nor Dr. Sippel has reported relevant financial relationships.

The American Association of Endocrine Surgeons. Abstract 29, presented April 15, 2013.