Cost Burden Follows Patients with Cancer into Survivorship

Charles Bankhead

September 2014, Vol 5, No 7 - Economics of Cancer Care

The high cost of cancer care follows patients well into survivorship, as annual medical costs and losses in productivity exceed those of people without cancer by 50% to 100%, a study for the Centers for Disease Control and Prevention (CDC) showed (Ekwueme DU, et al. MMWR Morb Mortal Wkly Rep. 2014;63:505-510).

The total annual medical and productivity costs (direct and indirect) for cancer survivors averaged $11,800 for men and $12,400 for women, according to this study. By comparison, medical and productivity costs for people without cancer averaged $6100 among men and $7800 among women. Given the growing number of cancer survivors in the United States, the projected averages and total costs will continue to increase as well.

“Cancer survivors face physical, emotional, psychosocial, employment, and financial challenges as a result of their cancer diagnosis and treatment,” stated Donatus U. Ekwueme, PhD, Senior Health Economist, Division of Cancer Prevention and Control at the CDC, and lead investigator of this study, in a press release. “With the number of cancer survivors expected to increase by more than 30 percent in the next decade—to 18 million Americans—medical and public health professionals must be diligent in their efforts to help reduce the burden of cancer on survivors and their families.”

The number of people in the United States living with cancer has more than quadrupled since 1971, from 3 million to 13.4 million. According to the National Cancer Institute (NCI), cancer survivors account for almost 5% of the US population.

To obtain current information about medical costs and productivity losses among cancer survivors, the investigators analyzed data from the Medical Expenditure Panel Survey (MEPS) for 2008 to 2011. The survey of cancer survivors includes items related to employment, limitations in physical and mental tasks, work-related productivity, and daily activities outside of work.

The sex-stratified total annual medical costs were derived from actual expenditures by cancer survivors and people without cancer. The researchers also evaluated medical costs by source of payment and by service type. Lost productivity was estimated from the combination of employment disability, health-related missed days of work, and illness-related days in bed. The medical costs and productivity losses were adjusted to 2011 dollars.

Economic Burden
Compared with people without cancer, cancer survivors were more likely to be female (51% vs 57.5%, respectively), to be non-Hispanic whites (66.1% vs 84.8%, respectively), to have ?3 comorbid conditions (16.6% vs 43.5%, respectively), and to report fair/poor health status (12.2% vs 28.1%, respectively).

Among employed cancer survivors, approximately 42% reported changes in work status, responsibilities, or behaviors as a result of cancer. Of the survivors, approximately 32% said that cancer adversely affected activities outside of work.

The medical expenditures and costs associated with lost productivity were substantially higher among cancer survivors than among those without a history of cancer, for both sexes. The medical costs for male cancer survivors averaged $8091 compared with $3904 for men without cancer. The averages for women were $8412 for cancer survivors and $5119 for women without cancer.

The productivity losses among cancer survivors averaged $3719 for men and $4033 for women. The corresponding values for people without cancer were $2260 for men and $2703 for women. Approximately 75% of productivity losses among cancer survivors (men and women) resulted from employment disability.

Approximately 10% of the cancer survivors reported being uninsured and might face added barriers to needed healthcare services. The investigators noted that provisions of the Affordable Care Act are expected to address some of the problems faced by uninsured cancer survivors by providing access to health insurance.

Survivorship Programs Needed
“The economic data presented in this report investigating the economic consequences of surviving cancer highlight the need to develop comprehensive intervention programs to improve the quality of the cancer survivorship experience and decrease the economic burden of cancer survivorship in the United States,” the researchers concluded.

This study is based on an ongoing collaborative effort called the Health Economics Research on Cancer Workgroup. Established to promote health economics research related to cancer, the workgroup consists of participants from the CDC, the NCI, the Agency for Healthcare Research and Quality (which sponsors MEPS), the American Cancer Society, the Livestrong Foundation, and Emory University in Atlanta, GA.

A primary objective of the collaboration is to address the research needs and gaps in information identified by the Institute of Medicine, including the 2005 landmark report, “From Cancer Patient to Cancer Survivor: Lost in Transition.”