Financial & Trend

Oncology Cost Projection Engine

Project 12-36 Month Cancer Treatment Costs by Stage, Modality, and Site-of-Care—From Diagnosis Through Survivorship

The $400K Cancer Budget Black Box

Traditional Cancer Cost Forecasting

✗Average $150K-$400K per cancer diagnosis—but massive variance by type, stage, treatment
✗CFOs can't model specific oncology pipeline: who has pre-cancer signals, who's in active treatment
✗Site-of-care cost differentials ignored (academic center vs. community vs. COE)
✗No modeling of immunotherapy vs. chemotherapy cost trajectories

Oncology Projection Engine

✓Stage-specific cost modeling: Stage I breast cancer ($45K) vs. Stage IV lung ($380K)
✓Active cancer pipeline visibility: current patients + pre-diagnosis screening signals
✓Site-of-care optimization: NCI-designated center steering saves 15-30%
✓Treatment modality cost curves: immunotherapy, targeted therapy, CAR-T, radiation, surgery

Cancer-Specific Forecasting Model

python
# Oncology Cost Projection
cancer_types = {
    'breast': {
        'stage_1': {'mean_cost': 45000, 'std': 12000, 'duration_months': 12},
        'stage_2': {'mean_cost': 85000, 'std': 22000, 'duration_months': 18},
        'stage_3': {'mean_cost': 165000, 'std': 45000, 'duration_months': 24},
        'stage_4': {'mean_cost': 290000, 'std': 80000, 'duration_months': 36}
    },
    'lung': {
        'stage_1': {'mean_cost': 95000, 'std': 25000, 'duration_months': 14},
        'stage_2': {'mean_cost': 175000, 'std': 48000, 'duration_months': 20},
        'stage_3': {'mean_cost': 285000, 'std': 75000, 'duration_months': 28},
        'stage_4': {'mean_cost': 380000, 'std': 110000, 'duration_months': 24}
    },
    'colorectal': {
        'stage_1': {'mean_cost': 55000, 'std': 15000, 'duration_months': 10},
        'stage_2': {'mean_cost': 95000, 'std': 28000, 'duration_months': 16},
        'stage_3': {'mean_cost': 145000, 'std': 42000, 'duration_months': 22},
        'stage_4': {'mean_cost': 240000, 'std': 70000, 'duration_months': 30}
    }
}

def project_oncology_cohort(active_cancer_members, high_risk_screening):
    total_exposure = 0
    
    # Active Treatment Pipeline
    for member in active_cancer_members:
        cancer_type = member.primary_cancer_dx
        stage = member.cancer_stage
        months_remaining = estimate_treatment_duration(member)
        
        base_cost = cancer_types[cancer_type][stage]['mean_cost']
        
        # Site-of-Care Adjustment
        if member.treating_at_coe:
            cost_multiplier = 0.85  # COE discount via negotiated rates
        elif member.treating_at_academic:
            cost_multiplier = 1.15  # Academic center premium
        else:
            cost_multiplier = 1.0
        
        projected_cost = base_cost * cost_multiplier * (months_remaining / 12)
        total_exposure += projected_cost
    
    # Pre-Diagnosis Risk Pool (screening signals)
    incidence_rate = 0.005  # 0.5% annual cancer incidence
    expected_new_cases = len(high_risk_screening) * incidence_rate
    avg_cost_new_dx = 120000  # Mixed stage distribution
    
    total_exposure += expected_new_cases * avg_cost_new_dx
    
    return {
        'current_active_treatment': len(active_cancer_members),
        'expected_new_diagnoses': expected_new_cases,
        'total_12mo_exposure': total_exposure,
        'p75_exposure': total_exposure * 1.25,
        'p90_exposure': total_exposure * 1.55
    }

Clinical & Financial Intelligence

Cancer Types Tracked

12 Major

Breast, lung, colorectal, prostate, lymphoma, leukemia, melanoma, pancreatic, ovarian, kidney, bladder, brain

Forecast Horizon

12-36 Months

Stage-specific treatment duration modeling

COE Steering Savings

15-30%

NCI-designated centers vs. community oncology

Oncology Budget Planning

Stage IV Lung Cancer

•Member diagnosed Q1 2025, starting immunotherapy
•Projected 24-month treatment cost: $380K
•Steered to NCI-designated center: $325K actual
•14% savings + access to clinical trials

Breast Cancer Cohort

•4 active members in treatment (Stage I-III)
•Combined projected exposure: $285K
•1 high-risk screening signal (BRCA+)
•Total 12-month budget: $345K (includes new dx probability)

CAR-T Therapy Planning

•2 lymphoma patients eligible for CAR-T
•Treatment cost: $475K each = $950K exposure
•Stop-loss laser placed at $400K specific
•Net plan exposure: $150K vs. $950K uninsured

Know Your Oncology Exposure Before It Hits

Project cancer treatment costs by stage, modality, and site-of-care. Budget with confidence, steer to Centers of Excellence, optimize stop-loss coverage.

Run Oncology Forecast→