Evidence for marked underutilization of insurance billing in malignant pleural mesothelioma in Finland

Our plain-English summary of Evidence for marked underutilization of insurance billing in malignant pleural mesothelioma in Finland, by P. Torkki, J. Paajanen, V. Kytö, et al (Thoracic Cancer, 2021).

The study

• Authors: P. Torkki, J. Paajanen, V. Kytö, S. Laaksonen, J. Räsänen, M. Myllärniemi, I. Ilonen
• Journal: Thoracic Cancer
• Published: 2021;12(19):2594-2600
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Substantial variation in health care costs for malignant pleural mesothelioma (MPM) has previously been identified.

Materials And Methods: We analyzed the changes in health care costs in MPM in Finland during 2002-2012. Finland has low-threshold public health care and a mandatory Workers' Compensation scheme that covers all occupational-related disease expenses. The costs include treatment costs for inpatients, hospice care, medication costs, rehabilitation costs, and travel costs. All costs are expressed in 2012 prices, adjusted using the consumer price index.

Results: A total of 907 MPM patients were included in the study. Mean duration of inpatient episodes increased 7% per year from 2002 to 2012, correlating with total costs (R2 = 0.861, p < 0.05). The annual total costs for treatment increased from 1.7 to 4.3 m€ during the study period and the cost per patient from 27 000 to 43 000 €. The overall costs increased progressively by the number of procedures performed. In patients who had been compensated for occupational cause by Workers' Compensation Center, only 36% of the overall care costs were billed from the insurance company. Billing of inpatient costs was 86% in these patients.

Conclusion: During the study period, we found that the costs of MPM increased more than the average health care costs. This may be because of advanced diagnostic workup or more costly treatment (e.g., pemetrexed). Moreover, only one-third of all health care costs are charged to Workers' Compensation Insurance.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This retrospective register study examined health care costs of 907 patients with malignant pleural mesothelioma in Finland from 2002 to 2012. Treatment costs rose from about 1.7 to 4.3 million euros, and cost per patient from around 27 000 to 43 000 euros, though the 2012 per-patient figure was only partially captured because care could continue later. Inpatient care made up 86% of costs. The average health care episode, from first hospital admission to last discharge, lengthened 7% per year, but inpatient days per patient showed no systematic change. Surgery patients cost more than those with only palliative or diagnostic procedures or none. For patients with mesothelioma verified as an occupational disease, Workers' Compensation insurance covered only 36% of overall care costs, though 86% of overnight inpatient fees. Occupational and non-occupational patients' total costs did not differ. The authors concluded that mesothelioma costs rose more than average health care costs, possibly from advanced diagnostic workup or more effective treatments, and that only part was charged to Workers' Compensation Insurance. They noted the registries lacked detailed treatment data.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective register study of health care costs, linking national cancer, hospital care and Workers' Compensation registries
• Who was studied: 907 patients with malignant pleural mesothelioma in Finland, with cost data for 2002–2012. They were drawn from a cohort of 1010 patients diagnosed in 2000–2012.
• Exposure: No asbestos fiber types or doses were studied. The study looked at health care costs and at how much was billed to Workers' Compensation insurance. Patients were cross-referenced with the Workers' Compensation registry to identify those compensated for an occupational cause.
• Main results:
  • Total treatment costs for mesothelioma rose from around 1.7 million euros to 4.3 million euros over the 10-year period. The real cost per patient rose from around 27 000 to 43 000 euros.
  • The 2012 per-patient treatment cost was only partially captured, because care episodes may continue into the following years.
  • The cumulative annual growth rate was 9.7% for total costs and 4.9% for cost per patient.
  • The average length of the health care episode rose 7% per year from 2002 to 2012. The episode was defined as running from the start of the first inpatient episode to discharge from the last.
  • The median number of inpatient days per patient was 41, with no systematic change between the years.
  • Inpatient episodes accounted for 86% of total costs. High patient-level costs were more related to the number of inpatient days than to the costs of procedures.
  • Over the whole study period, the median cost per patient was 26 400 euros and the average cost was 36 600 euros. Costs exceeded 50 000 euros in 20% of patients, and these patients accounted for 50% of total costs.
  • For patients with mesothelioma verified as an occupational disease, Workers' Compensation insurance covered only 36% of overall care costs (5.6 million euros).
  • Among patients with over 10 000 euros compensated through Workers' Compensation, the compensation rate was 54.0% of overall expenses.
  • Overnight inpatient fees were compensated at a rate of 86% by Workers' Compensation.
  • Median total cost was 25 898 euros (8342 to 65 949 euros) for patients with occupational disease and 27 534 euros (7136 to 72 513 euros) for non-occupational patients. The authors reported that total cost did not differ between the groups.
  • Costs rose with the complexity of procedures. Median cost per patient was 38 906 euros for surgery (148 patients), 29 511 euros for palliative or diagnostic procedures (327 patients) and 20 952 euros for no procedure (185 patients). Differences between all groups were reported as statistically significant.
• The authors' conclusion: The authors concluded that mesothelioma costs increased more than average health care costs during the study period, and that longer treatment episodes resulted in higher total costs, possibly because of advanced diagnostic workup or more effective treatments. They also concluded that only a portion of health care costs were charged to Workers' Compensation Insurance. In their discussion, they suggested that both occupational diseases and cost claims had been underreported.
• Limitations the authors state:
  • The Finnish Cancer Registry does not reliably collect treatment data, so doses and length of cancer care could not be studied, and treatments were not specified separately from total costs.
  • Diagnostic studies were not quantified, and procedure records gave no information on the extent or outcome of surgery or procedures.
  • Inpatient and outpatient medication costs could not be separated individually.
  • Mesothelioma-related costs could not be distinguished from total costs.
  • The compensation system underreports some compensated costs because some patients received the occupational diagnosis only at autopsy.
  • The study period is not up to date.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Hospice, Pemetrexed (Alimta).

Related studies

• Insurance, reinsurance and underwriting names' liability for asbestos-related diseases — M. Weller (1992)
• Malignant pleural mesothelioma in Finland: regional and gender variation — S. Laaksonen, I. Ilonen, et al. (2019)
• Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability — P.F. Bagnoli, F.C. Cananzi, et al. (2015)
• In Australia, patients and government at odds over mesothelioma treatment costs — V. Burkitt (2007)
• Breast cancer and occupational exposures in women in Finland — E. Weiderpass, E. Pukkala, et al. (1999)
• Retrospective exposure assessment for carcinogenic agents in bitumen waterproofing industry in Finland and denmark — P. Anttila, P. Heikkilä, et al. (2009)

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