Abstract
INTRODUCTION
Management of brain and central nervous system malignancies is associated with substantial healthcare spending, yet estimates of per-patient cost and longitudinal temporal trends remain elusive. In this study, we investigate trends in United States (US) healthcare spending on these diseases between 1996-2016.
METHODS
We utilize inflation-adjusted national healthcare spending data and age-adjusted prevalence estimates from the Institute for Health Metrics and Evaluation to estimate per-patient US healthcare spending stratified by age and care setting. We employ joinpoint regression to identify temporal trends in healthcare spending, expressed as annual percent change (APC). Drivers of change data from 1996-2013 were evaluated to investigate shifts associated with increased spending.
RESULTS
In 2016, total healthcare spending attributable to brain and nervous system cancers was $6.85 billion (95% CI, $5.98-7.57 billion), corresponding to $2,245 (95% CI $1,962-$2,480) per patient, with the largest share coming from inpatient care settings ($4.60 billion [95% CI 3.87-5.24 billion]). Private payers shouldered the majority of costs (65.6%) compared to public payers (28.1%) and out-of-pocket expenses (6.4%). The average APC in spending between 1996-2016 was 3.69% [95% CI 3.00%-4.39%], driven primarily by an increase in the price and intensity of inpatient care (11.8% [95% CI 7.7%-16.1%). Further, three statistically significant periods of spending change were identified: 1996-2005 (2.42% [95% CI 2.04-2.80%], p < 0.001 ), 2005-2008 (4.43% [95% CI 1.08%-7.89%], p < 0.0001), 2008-2014 (6.32% [95% CI 5.41%-7.25%], p < 0.001), with spending being relatively stable from 2014-2016.
DISCUSSION
US expenditures for brain and nervous system malignancies are substantial and have significantly increased between 1996-2016, largely driven by increased inpatient spending. These findings may inform policy efforts to reduce the disease burden while balancing healthcare spending.