The economic burden of gynecologic cancers in California, 1998.

OBJECTIVE: Our aim was to estimate the direct and indirect costs of gynecologic cancers including cervical, ovarian, and uterine cancer in California in 1998. METHODS: Hospitalization costs, including costs of primary and secondary diagnoses of each of the gynecologic cancers, are derived from the California Patient Discharge dataset. Charges are converted to costs using hospital-specific cost-to-charge ratios and an imputed cost for HMO hospitalizations. Other direct medical costs are derived from the 1997 Medical Expenditure Panel Survey. Indirect mortality costs are the product of the number of deaths and the expected value of a female's future earnings, including an imputed value of housekeeping services. RESULTS: The total cost of the three gynecologic cancers in California is estimated at $624 million for 1998. Indirect costs or losses in productivity due to premature death are twice the direct medical care costs. Hospitalization inpatient costs account for more than half of total direct costs for each of these cancers. Total costs for ovarian cancer are highest among the three cancers. CONCLUSIONS: The estimates presented here highlight the need for studies that identify cost-effective screening methods and the relationship between treatment protocols and outcomes. The methods presented here could be used to develop stage- or treatment-specific costs that would be useful for such analyses. Only through early detection and more effective management of gynecologic cancers can there be a reduction in the morbidity, premature death, and high costs of cervical, ovarian, and uterine cancers.

Cervical intraepithelial lesions and cervical cancer among Asian Pacific Islander women in a cervical cancer screening program.

Utilizing data from a cervical cancer screening program in California, we examined the relationship between being a woman of Asian/Pacific Islander (API) origin and receiving different types of abnormal cervical diagnoses. Initial descriptive data reflected a higher than expected percentage of API subjects with a final diagnosis of in situ and invasive cervical cancer when compared with other subjects in other ethnic groups (N = 2792). Results of multivariate analysis indicated that being of API origin retained significance in a model explaining the level of severity of the cervical final diagnosis, even when controlling for other significant predictors such as having a prior pap smear, age, referral source, the presence of cervical abnormalities and the time from screening to diagnosis. We conclude that women of API origin may not be accessing health care sufficiently early to prevent increasingly severe final diagnoses. Utilizing data from a cervical cancer screening program in California, we examined the relationship between being a woman of Asian/Pacific Islander (API) origin and receiving different types of abnormal cervical diagnoses. Initial descriptive data reflected a higher than expected percentage of API subjects with a final diagnosis of in situ and invasive cervical cancer when compared with other subjects in other ethnic groups (N = 2792). Results of multivariate analysis indicated that being of API origin retained significance in a model explaining the level of severity of the cervical final diagnosis, even when controlling for other significant predictors such as having a prior pap smear, age, referral source, the presence of cervical abnormalities and the time from screening to diagnosis. We conclude that women of API origin may not be accessing health care sufficiently early to prevent increasingly severe final diagnoses.

The economic burden of prostate cancer, California, 1998.

BACKGROUND: Prostate cancer is the most common malignancy diagnosed among men in the United States. This article reviews previous studies of the annual cost of all cancers and of prostate cancer in the United States and California and estimates the direct and indirect costs of prostate cancer in California in 1998. METHODS: Hospitalization costs, including costs of primary and secondary diagnoses of prostate cancer, were derived from the California Hospital Discharge data set (CHDS). Charges were converted to costs using hospital specific cost-to-charge ratios and an imputed cost for Health Maintenance Organization hospitalizations. Other direct medical costs were derived from the 1997 Medical Expenditure Panel Survey. Indirect mortality costs are the product of the number of deaths and the expected value of a male's future earnings taking into account age at death, earning patterns at successive ages, labor force participation, imputed value of housekeeping services, and a 3% discount rate. RESULTS: Prostate cancer direct health care costs in California were estimated at 180 million dollars, and lost productivity from premature death was estimated at 180 million dollars, for a total cost of 360 million dollars in 1998. The disease is largely one of older men; hospitalization costs account for three-fifths of total direct costs, and Medicare and private health insurance share almost equally in paying for hospital care. CONCLUSIONS: It is critical to identify cost-effective screening efforts that permit early detection of prostate cancer to reduce illness, premature deaths, and the high costs of prostate cancer.