Objectives To describe healthcare system costs and utilization between symptomatic presentation and ovarian cancer diagnosis in the United States.
Methods A population-based study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database was conducted on patients ≥66 years old with stage II-IV epithelial ovarian cancer between 1992–2015 with at least one of the following diagnosis codes in the year before diagnosis: abdominal pain, bloating, difficulty eating, and/or urinary symptoms. The outcomes were cost and type of healthcare system utilization between first symptomatic claim and cancer diagnosis date for any reason. Jonckheere-Terpstra and Cochran-Armitage tests evaluated trends over time.
Results Among 13,872 women, the most common imaging was CT (67.6%), followed by pelvic ultrasound (49.5%), MRI (4.2%), and PET (1.2%). Between 1992–2015, frequency of ultrasound decreased (p<.001) while CT, MRI, PET, and CA-125 increased (p<.001). In the overall cohort, median cost per month was $13,941 for hospitalizations, $2041 for outpatient visits, and $218 for emergency room (ER) visits. Median monthly total, inpatient, and outpatient costs decreased (p<.001) while ER costs increased over time (p<.001). The number of outpatient visits (p<.001) and frequency of ER visits (p<.001) increased while frequency of hospitalizations (p<.001) decreased over time. Median hospital length of stay decreased from 10 days in 1992 to 5 days in 2015 (p<.001).
Conclusions Healthcare utilization costs between symptomatic presentation and ovarian cancer diagnosis have decreased over time and reflect the trends in fewer and shorter hospitalizations and increased use of ER and outpatient management during the evaluation of symptoms of women with ovarian cancer.
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