List of procedures that cost Medicare (and patients) the most money

Data from the recently released Medicare provider utilization and payment data contain cost information for over 5000 procedures performed for seniors in the United States in 2012. The data is a little complicated and contains some biases.  However, with a little care it is possible to identify the most expensive procedures and get an understanding of the monetary value our healthcare system has assigned to human life.

The costs that are reported in the data set are for a single procedure. However, if a course of therapy requires that a procedure be repeated multiple times, then the real cost is higher. In order to get an understanding of annual cost, we need the number of procedures in a course of therapy. To get this we divide the number of times a procedure was completed by the number of unique patients receiving that procedure (both available in the data). This is still an underestimate because we only have data on procedures performed in 2012 while the course of therapy may have extended into either 2011 or 2013.

 The table lists 37 therapeutic options that cost more that $10,000 for a course of therapy in 2012. Focusing just on treatments for cancer that are listed in the table (in orange) we see that the value of a month of life varies from $2,333 for Oxaliplatin to treat colorectal cancer to $29,709 for Ipilimumab to treat melanoma.

By not specifically setting a price on human life, we are allowing the free(ish) market to make those decisions. That isn't inherently good or bad, but free market in the American healthcare system is distorted by perverse incentives and high levels of information asymmetry. The patients, physicians, payers and makers of therapeutics all have vastly different levels of understanding of the value and cost of therapies. In a later article, we will look at some specific examples of how this leads to therapeutic decisions that aren't necessarily optimal for patients.

Expensive Therapeutics.  Rows colored in orange are cancer medications, rows in blue are not medications.  The value "continuous" in the column "boosted overall survival" means that the drug must be taken continuously for the life of the patient.  Overall survival is drawn from cancer.gov and therapeutic indication is drawn from the FDA label for the medication.

Code	Procedure	Therapeutic Indication	Average Allowed Payment	patients in dataset	Bosted overall survival (months)	Cost per month of life ($)
J7192	Factor viii recombinant NOS	Hemophelia	249877.5	357	continuous	20,823
J7187	Humate-P, inj	Hemophelia	211461.2	12	continuous	17,622
J7193	Factor IX non-recombinant	Hemophelia	186561.1	13	continuous	15,547
J7195	Factor IX recombinant	Hemophelia	185380.8	43	continuous	15,448
J1786	Imuglucerase injection	Hemophelia	133782.8	35	continuous	11,149
J7190	Factor viii	Hemophelia	132205.5	55	continuous	11,017
J9228	Ipilimumab injection	Melanoma	118836.5	71	4	29,709
Q2043	Sipuleucel-T auto CD54+	Prostate cancer	63459.8	274	4.1	15,478
Q3025	IM inj interferon beta 1-a	Multiple sclerosis	28033.83	17
J1561	Gamunex/gamunex c	Primary Immuno- deficiency	26335.92	1393	Continuous	2,195
J9043	Cabazitaxel injection	Prostate Cancer	25994.92	29	2.4	10,831
J2353	Octreotide injection, depot	Cancer supportive care	20100.57	906
J0490	Belimumab injection	Lupus	19702.11	122
J2796	Romiplostim injection	Chronic ITP	18650.44	82	Continuous	1,554
J9055	Cetuximab injection	colorectal cancer  head/neck cancer	18291.55	708	colorectal: 1.1  head/neck: .8	colorectal: 16,628 head/neck: 22,864
77523	Proton trmt intermediate	various cancers	17700.16	887
L8687	Implt nrostm pls gen dua rec		16881.23	95
J9305	Pemetrexed injection	lung cancer	16869.75	3048	non-squamous: 2.8  mesothelioma: 2.8	non-squamous: 6,025 mesothelioma: 6,025
0182T	Hdr elect brachytherapy	various cancers	16852.01	540
J2323	Natalizumab injection	Crohn's disease, multiple sclerosis	16348.39	2716
J1572	Flebogamma injection	Primary Immuno- deficiency	15625.81	209	Continuous	1,302
J9310	Rituximab injection	Leukemia, lymphoma	15078.95	35654
J2562	Plerixafor injection	non-Hodgkin lymphoma, multiple myeloma	14181.41	12
J9355	Trastuzumab injection	HER2 Gastric cancer    HER2 Breast cancer	13762.43	2773	Gastric: 2.4	5,734
37231	Tib/per revasc stent & ather	revascular- ization surgery	13452.13	441
J1745	Infliximab injection	Crohn's, Ulcerative Colitis, Arthritis	13430.7	42645
J1568	Octagam injection	Primary Immuno- deficiency	12171.14	1397	Continuous	1,014
77600	Hyperthermia treatment	various cancers	12111.14	77
J1569	Gammagard liquid injection	Primary Immuno- deficiency	11939.5	1586	Continuous	995
J1459	Inj IVIG privigen 500 mg	Primary Immunodeficiency, Chronic ITP	11832.02	663	Continuous	986
37227	Fem/popl revasc stnt & ather	revascular- ization surgery	11535.57	4319
J9263	Oxaliplatin	Colorectal cancer	11196.69	8164	4.8	2,333
J3262	Tocilizumab injection	Rheumatoid arthritis	10997.55	2216	Continuous	916
36516	Apheresis selective	Various	10901.78	42
J9264	Paclitaxel protein bound	pancreatic cancer, lung cancer, breast cancer	10605.92	1041	pancreatic: 1.8	pancreatic: 5,892
J0129	Abatacept injection	Arthritis	10231.23	13916	Continuous	853
J2357	Omalizumab injection	asthma, idiopathic urticaria	10042.75	2770	Continuous	837