Healthcare Cost and Utilization Differences among American Indian and Alaska Native Compared with Non-Hispanic White Patients with Lung Cancer

Abstract

Lung cancer is the leading cause of cancer death in the United States and survival rates of American Indian and Alaska Native (AIAN) patients are worse than those of non-Hispanic White (NHW) patients. A contributing factor to the worse outcomes may be lower healthcare utilization of AIAN patients. But improving healthcare utilization of AIAN to levels used comparable to those of NHW might increase costs of their care to amounts comparable to those of NHW. Objectives: 1) To examine differences in total healthcare costs and healthcare utilization 12 months following lung cancer diagnosis between AIAN patients and NHW patients, 2) To examine differences in total healthcare costs and healthcare utilization during the end-of-life period (last 6 months of life) between AIAN patients and NHW patients who died from lung cancer or any cause, and 3) To compare the incidence of depression disorder 60 months after cancer diagnosis and determine depression treatment utilization among those with a depression disorder. Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset was used. Patients included in the study were those age 65 years and older, diagnosed with lung cancer between 2000 and 2011, Part A coverage, Part B coverage and no managed care plan before. Diagnosis and procedure codes were used to identify costs, utilization, and depression diagnoses. The propensity score matching method was used to balance groups. A generalized linear model (GLM) was used for costs analysis and the negative binomial regression model was used to analyze healthcare utilization. A Cox proportional hazards regression model was used to identify risk factors for new diagnosis of depression. Results: Being AIAN was associated with lower total healthcare costs 12 months following lung cancer diagnosis. In contrast, being AIAN was not associated with total healthcare costs six months before date of death among patients diagnosed with lung cancer and ≤ 6 month survival time. The incidence of diagnosis of depression disorder 60 months after lung cancer diagnosis was 3.67% for AIAN patients and 6.16% for NHW patients. The mean number of depression treatment visits suggests higher utilization among AIAN patients compared with NHW patients. AIAN patients were not at increased risk for depression after cancer diagnosis. Conclusions: The healthcare utilization of AIAN patients with lung cancer could be improved while keeping costs of care no higher than those of NHW patients. But any improvements of health care use would need to take account of the variability among AIAN patients receiving health care 12 months following cancer diagnosis, in the last six months of life, and after depression disorder diagnosis.