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Economics Research: Publications since January 2020

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%% Yashkin, Arseniy   
   Author = {Sloan, FA and Yashkin, AP and Akushevich, I and Inman,
   Title = {The Cost to Medicare of Bladder Cancer Care.},
   Journal = {Eur Urol Oncol},
   Volume = {3},
   Number = {4},
   Pages = {515-522},
   Year = {2020},
   Month = {August},
   url = {},
   Abstract = {BACKGROUND: Bladder cancer care is costly, including cost to
             Medicare, but the medical cost associated with bladder
             cancer patients relative to identical persons without
             bladder cancer is unknown. OBJECTIVE: To determine
             incremental bladder cancer cost to Medicare and the impact
             of diagnosis stage and bladder cancer survival on cost.
             DESIGN, SETTING, AND PARTICIPANTS: A case-control study was
             conducted using 1998-2013 Surveillance, Epidemiology and End
             Results-Medicare data. Controls were propensity score
             matched for diagnosis year, age, gender, race, and 31
             Elixhauser Comorbidity Index values. Three incident cohorts,
             1998 (n=3136), 2003 (n=7000), and 2008 (n=7002), were
             Survival following diagnosis and Medicare payments (in 2018
             dollars) were tabulated, and compared between cases and
             controls. RESULTS AND LIMITATIONS: From 1998 to 2008,
             bladder cancer patients became older and had more
             comorbidities at diagnosis, although no stage migration or
             change in survival occurred. Incremental costs (above those
             associated with controls) were highest during the 1st year
             after diagnosis and were higher for distant ($47533) than
             for regional ($42403) or localized ($14304) cancer. Bladder
             cancer survival was highly stage dependent. After an initial
             spike in costs lasting 1-2yrs, monthly costs dropped in
             survivors but remained higher than for controls. Long-term
             survivors in the full sample accrued cumulative Medicare
             costs of $172426 over 16yrs-46% higher than for controls.
             Limitations include omission of indirect costs and reliance
             on traditional Medicare. CONCLUSIONS: While a bladder cancer
             diagnosis incurs initial high Medicare cost, particularly in
             patients with advanced cancers, the cumulative costs of
             bladder cancer in long-term survivors are higher still.
             Bladder cancer prevention saves Medicare money. However,
             while early detection, better therapies, and life extension
             of bladder cancer patients are worthwhile goals, they come
             at the cost of higher Medicare outlays. PATIENT SUMMARY: The
             lifetime cost of bladder cancer, reflecting surveillance,
             treatment, and management of complications, is substantial.
             Since care is ongoing, cost increases with the length of
             life after diagnosis as well as the severity of initial
   Doi = {10.1016/j.euo.2019.01.015},
   Key = {fds352299}

   Author = {Akushevich, I and Yashkin, AP and Inman, BA and Sloan,
   Title = {Partitioning of time trends in prevalence and mortality of
             bladder cancer in the United States.},
   Journal = {Ann Epidemiol},
   Volume = {47},
   Pages = {25-29},
   Year = {2020},
   Month = {July},
   url = {},
   Abstract = {PURPOSE: The aim of the study was to evaluate the relative
             contributions of incidence, stage-specific relative
             survival, and stage ascertainment to changes in bladder
             cancer (BC) prevalence and incidence-based mortality.
             METHODS: Partitioning of prevalence and incidence-based
             mortality trends into their epidemiologic components.
             RESULTS: BC prevalence estimated from our model increased
             but at monotonically decreasing rates until 2007, after
             which it decreased again. The main forces underlying
             observed trends in BC prevalence were relative BC survival,
             which improved throughout the period, and BC incidence,
             which increased at a decreasing rate until 2005 and declined
             thereafter. Mortality of persons ever diagnosed with BC
             increased at an increasing rate until 1997, increased at a
             decreasing rate from 1997 to 2005, and decreased thereafter.
             The primary forces accounting for mortality trends were
             changes in mortality in the general population, which
             improved at an increasing rate during most of 1992-2010, the
             most important factor, and changes in incidence. Stage
             ascertainment did not improve during 1992-2010. CONCLUSIONS:
             Although mortality rates improved, these gains largely
             reflected improvements in U.S. population survival rather
             than from improvements in BC-specific outcomes.},
   Doi = {10.1016/j.annepidem.2020.05.006},
   Key = {fds350513}

   Author = {Sloan, FA and Yashkin, AP and Akushevich, I and Inman,
   Title = {Longitudinal patterns of cost and utilization of medicare
             beneficiaries with bladder cancer.},
   Journal = {Urol Oncol},
   Volume = {38},
   Number = {2},
   Pages = {39.e11-39.e19},
   Year = {2020},
   Month = {February},
   url = {},
   Abstract = {BACKGROUND: Bladder cancer (BC) is highly prevalent and
             costly. This study documented cost and use of services for
             BC care and for other (non-BC) care received over a 15-year
             follow-up period by a cohort of Medicare beneficiaries
             diagnosed with BC in 1998. METHODS: Data came from the
             Surveillance, Epidemiology and End Results Program linked to
             Medicare claims. Medicare claims provided data on diagnoses,
             services provided, and Medicare Parts A and B payments. Cost
             was actual Medicare payments to providers inflated to 2018
             US$. Cost and utilization were BC-related if the claim
             contained a BC diagnosis code. Otherwise, costs were for
             "other care." For utilization, we grouped Part B-covered
             services into 6 mutually-exclusive categories. Utilization
             rates were ratios of the count of claims in a particular
             category during a follow-up year divided by the number of
             beneficiaries with BC surviving to year-end. RESULTS:
             Cumulatively over 15-years, for all stages combined, total
             BC-related cost per BC beneficiary was $42,011 (95%
             Confidence Interval (CI): $42,405-$43,417); other care cost
             was about twice this number. Cumulative total BC-related
             cost of 15-year BC survivors for all stages was $43,770 (CI:
             $39,068-$48,522), intensity of BC-related care was highest
             during the first year following BC diagnosis, falling
             substantially thereafter. After follow-up year 5, there were
             few statistically significant changes in BC-related
             utilization. Utilization of other care remained constant
             during follow-up or increased. CONCLUSIONS: Substantial
             costs were incurred for non-BC care. While increasing BC
             survivorship is an important objective, non-BC care would
             remain a burden to Medicare.},
   Doi = {10.1016/j.urolonc.2019.10.016},
   Key = {fds347334}

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