Healthcare expenditures among community-dwelling adults with thyroid cancer in the United States: A propensity score matched analysis

Sandipan Bhattacharjee,Moteb Khobrani,Ziyad Alrabiah,Jawad Bilal,Irbaz Bin Riaz

doi:10.1016/j.heliyon.2019.e01995

Sandipan Bhattacharjee, Moteb Khobrani + Show 3 more

Open Access

https://doi.org/10.1016/j.heliyon.2019.e01995

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Abstract

ObjectiveThis study assessed the excess healthcare expenditures and factors associated with it among community-dwelling adults with thyroid cancer compared to non-cancer controls in the United States. MethodA retrospective, cross-sectional, matched case-control study design was used by pooling multiple years of Medical Expenditure Panel Survey (MEPS) data (2002–2012). The eligible study sample comprised of adults (age ≥18 years), who were alive during the calendar year and reported positive healthcare expenditure. The case group consisted of adults with thyroid cancer only while the control group consisted of adults who did not have any form of cancer. Total and subtypes of mean annual healthcare expenditures comprised the main study outcome. We also calculated the total and subtypes of out-of-pocket (OOP) expenditures as well as OOP as a percentage of household income. Ordinary Least Square (OLS) regressions on log-transformed expenditures were conducted to elucidate the influence of different factors on healthcare expenditures among adults with thyroid cancer. ResultsThe yearly average total healthcare expenditures among adults with thyroid cancer was significantly higher compared to propensity score matched controls ($9,585 vs. $5,830, p < 0.001). Similar observations were found in terms of inpatient, and outpatient expenditures. Functional status as well as comorbid conditions were significantly associated with excess expenditures. The yearly average total OOP expenditure for adults with thyroid cancer was significantly higher compared to matched controls ($1,425 vs. $974, p < 0.001), with major differences observed in inpatient OOP ($178 vs. $24, p = 0.003), outpatient OOP ($435vs. $256, p < 0.001), and prescription OOP ($554 vs. $423, p < 0.001) expenditures. There was a significant (p < 0.001) difference between the average OOP as a percentage of household income between adults with thyroid cancer (Mean: 7.54%, S.E: 1.52%) and matched controls (Mean: 5.80%, S.E: 0.47%). ConclusionsOur findings suggest that holistic care approach could be helpful to significantly reduce the economic burden in this population. Viable strategies such as limits on OOP costs are required to minimize this high OOP burden among cancer survivors and their families.

Highlights

Thyroid cancer is considered a fairly common type of cancer, with an estimated 637,115 individuals having the disease in the United States (US) in 2013 [1]
Due to the high sample size of the non-cancer control group, we matched 208 adults with thyroid cancer to 624 adults without cancer based on propensity score, without losing sample from the case group
Prior to propensity score matching, the two groups were significantly different in terms of gender, poverty status, perceived physical and mental health status, instrumental activities of daily living (IADL) limitations, co-occurring chronic conditions and smoking status

Summary

Introduction

Thyroid cancer is considered a fairly common type of cancer, with an estimated 637,115 individuals having the disease in the United States (US) in 2013 [1]. A handful of studies in US examined the costs associated with thyroid cancer [10, 11, 12].It is crucial to estimate the burden of this disease for an appropriate utilization of specific treatment modalities and health care services in light of rising trends in incidence. The total cost for an incident cohort of thyroid cancer diagnosed in 2010 was approximately $1.4 billion and this number is projected to increase to more than $2.38 billion for the 2019 cohort. Another study using the SEER data conducted a stacked cohort cost analysis from 1985-2013 to estimate current and future healthcare expenditures attributable to well-differentiated thyroid cancer (WDTC) [12]. This study conducted by Lubitz et al (2014) estimated the current societal costs of WDTC to be $1.6 billion in 2013 and predicted the future costs to be $3.5 billion in 2030 based on present incidence trends [12]

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