Economist Jean Mitchell received a three-year, $1.7 million grant from NCI to assess treatment patterns and outcomes of women over 65 with newly diagnosed ductal carcinoma in situ (DCIS).
“Some cancer experts maintain that DCIS, which doesn’t metastasize and is not life-threatening, is often over-diagnosed and treated aggressively at a rate comparable to women diagnosed with early stage invasive breast cancer,” says Mitchell, an expert on health economics, health services research and applied econometrics. “Yet there is a dearth of studies looking at the impact of this trend on healthcare expenditures.”
Mitchell’s co-investigators on the DCIS study are Claudine Isaacs and Arnold Potosky of the Lombardi Comprehensive Cancer Center and Thomas DeLeire, also a professor at the McCourt School.
Critical to Medicare
She says her findings will likely have significant implications for practice guidelines and reimbursement policies, and that if less aggressive treatment is shown not to result in adverse clinical outcomes, doctors should be able to identify patients who may not need aggressive treatment.
“The results will also reveal if certain provider attributes are linked to aggressive treatment of DCIS,” says Mitchell, the author of 90 related peer-reviewed articles. “Such information is critical to Medicare and other third-party payers in their efforts to set reimbursement rates that maximize health care value.”
Prostate Cancer Study
The three-year, $1.2 million from the Agency for Healthcare Research and Quality, aims to assess the value of aggressive treatment of low-risk prostate cancer in men over 65.
According to the American Cancer Society (ACS), 90-percent of men diagnosed with prostate cancer in 2014 had a clinically localized form of the disease. The 10-year survival rate among men with this cancer is 99 percent ACS reports.
“Despite these facts, healthcare professionals have not adopted a unified treatment method,” says Mitchell, who notes that two-thirds of men diagnosed with prostate cancer are over 65. “This has led in many cases to unnecessarily aggressive treatment and high costs.”
The research aims to evaluate whether and how provider attributes affect the type of treatment, whether receipt of aggressive treatment compared to conservative management affects the probability of experiencing adverse health outcomes, andwhether getting aggressive treatment compared to conservative management affects cancer-related expenditures.