Comprehensive Cancer Centers: Expensive But Fast

An article I coauthored, “Comparing hospital costs and length of stay for cancer patients in New York State Comprehensive Cancer Centers versus nondesignated academic centers and community hospitals“, was just published in Health Services Research. We find that:

Inpatient costs were 27% higher (95% CI 0.252, 0.285), but length of stay was 12% shorter (95% CI −0.131, −0.100), in Comprehensive Cancer Centers relative to community hospitals.

In other words, these cutting-edge hospitals that tend to treat complex cases are more expensive, as you would expect; but despite getting tough cases they actually manage a shorter average length of stay. We can’t nail down the mechanism for this but our guess is that they simply provide higher-quality care and make fewer errors, which lets people get well faster.

What are Comprehensive Cancer Centers? Here’s what the National Cancer Institute says:

The NCI Cancer Centers Program was created as part of the National Cancer Act of 1971 and is one of the anchors of the nation’s cancer research effort. Through this program, NCI recognizes centers around the country that meet rigorous standards for transdisciplinary, state-of-the-art research focused on developing new and better approaches to preventing, diagnosing, and treating cancer.

Our paper focuses on New York state because of their excellent data, the New York State Statewide Planning and Research Cooperative System Hospital Inpatient Discharges dataset, which lets us track essentially all hospital patients in the state:

We use data on patient demographics, total treatment costs, and lengths of stay for patients discharged from New York hospitals with cancer-related diagnoses between 2017 and 2019.

You know I’m all about sharing data; you can find our data and code for the paper on my OSF page here.

My coauthor on this paper is Ryan Fodero, who wrote the initial draft of this paper in my Economics Senior Capstone class last Fall. He is deservedly first author- he had the idea, found the data, and wrote the first draft; I just offered comments, cleaned things up for publication, and dealt with the journal. I’ve published with undergraduates several times before but this is the first time I’ve seen one of my undergrads hit anything close to a top field journal. You can find a profile of Ryan here; I suspect it won’t be the last you hear of him.