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23 April 2009

Healthcare claims for identifying the level of diagnostic investigation and treatment of cancer

Ray M. MerrillACDEF, Randy K. BakerACDE, Joseph L. LyonDEG, Lisa H. GrenDE

Med Sci Monit 2009; 15(5): PH25-31 :: ID: 869626

Abstract

Background
Healthcare claims data were used to better understand the diagnostic investigation and treatment of cancer.
Material and Method
A retrospective cohort study was used involving claims data from a large insurance company. Analyses were based on electronic claims data from 1997 through 2006 for enrollees aged 15-64 years.
Results
This study showed that 96% of all first time cancer-related claims involved physician services. The percentage of physician services involving diagnostic workup in the form of some combination of blood testing, radiology, and surgery was 89% for non-skin cancer and 95% for skin cancer. The percentage of physician services involving some combination of chemotherapy, radiation, and surgery was 24% for non-skin cancer and 14% for skin cancer. Thus, for cancer (excluding skin cancer) the ratio of diagnostic workup to treatment was 2.7 to 1. For skin cancer, the ratio was 6.3 to 1. The percentage receiving treatment ranged from 13% for the male genital system to 46% for cancers of the bones and joints. Beyond cancers of the male or female genital systems, cancer-related claims involving treatment were 34% (95% CI 17-54%) higher for females than males.
Conclusions
Healthcare claims data can be used to generate useful information for physicians and their patients about the process and nature of the diagnostic workups and treatment that typically occur when cancer is suspected.

Keywords: Insurance Claim Review, Cohort Studies, Neoplasms - therapy, Adolescent, young adult

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750