Economic burden of cancer survivorship among adults in the United States

Abstract

Purpose: To present nationally representative estimates of the impact of cancer survivorship on medical expenditures and lost productivity among adults in the United States.

Methods: Using the 2008 to 2010 Medical Expenditure Panel Survey, we identified 4,960 cancer survivors and 64,431 individuals without a history of cancer age ≥ 18 years. Direct medical costs were measured using annual health care expenditures and examined by source of payment and service type. Indirect morbidity costs were estimated from lost productivity as a result of employment disability, missed work days, and lost household productivity. We evaluated the economic burden of cancer survivorship by estimating excess costs among cancer survivors, stratified by time since diagnosis (recently diagnosed [≤ 1 year] and previously diagnosed [> 1 year]), compared with individuals without a history of cancer using multivariable regression models stratified by age (18 to 64 and ≥ 65 years), controlling for age, sex, race/ethnicity, education, and comorbidities.

Results: In 2008 to 2010, the annual excess economic burden of cancer survivorship among recently diagnosed cancer survivors was $16,213 per survivor age 18 to 64 years and $16,441 per survivor age ≥ 65 years. Among previously diagnosed cancer survivors, the annual excess burden was $4,427 per survivor age 18 to 64 years and $4,519 per survivor age ≥ 65 years. Excess medical expenditures composed the largest share of the economic burden among cancer survivors, particularly among those recently diagnosed.

Conclusion: The economic impact of cancer survivorship is considerable and is also high years after a cancer diagnosis. Efforts to reduce the economic burden caused by cancer will be increasingly important given the growing population of cancer survivors.

Fig 1.

Percentage of medical expenditures by (A) source of payment and (B) service type. Recently diagnosed was defined as being diagnosed ≤ 1 year from the time of survey, previously diagnosed was defined as being diagnosed more than 1 year from the time of survey. Adjusted percentages are from predicted marginals from a generalized linear model with a gamma distribution and a log link controlling for age, sex, race/ethnicity, and number of comorbid conditions. Other payment sources included Veterans Affairs, TRICARE, other federal sources, other state and local sources, worker's compensation, other unclassified sources, other private sources, and other public sources. Ambulatory care includes office-based provider visits and outpatient visits. Other services include emergency room visits, home health visits, dental visits, vision expenses, and other medical expenditures.

Fig 2.

Aggregate annual net medical expenditure ranges by service type among adult cancer survivors (A) age 18 to 64 years and (B) age ≥ 65 years. National level aggregate net medical expenditures were calculated by multiplying the number of cancer survivors in each age group by the per-person excess expenditure. Prevalence estimates from the Medical Expenditure Panel Survey (MEPS) sample weights and age-specific estimates calculated from cancer registries were used to estimate a plausible range. Ambulatory care includes office-based provider visits and outpatient visits. Other services include emergency room visits, home health visits, dental visits, vision expenses, and other medical expenditures.

Fig 3.

Aggregate annual net productivity loss ranges among adult cancer survivors (A) age 18 to 64 years and (B) age ≥ 65 years. National-level aggregate net productivity loss was calculated by multiplying the number of cancer survivors in each age group by the per-person excess cost. Prevalence estimates from the Medical Expenditure Panel Survey (MEPS) sample weights and age-specific estimates calculated from cancer registries were used to estimate a plausible range.