Department of Health Policy and Administration, Center for Health Care and Policy Research, The Pennsylvania State University, University Park, PA 16802, USA.
Cancer. 2011 Jun 15;117(12):2791-800. doi: 10.1002/cncr.25835. Epub 2010 Dec 23.
To the authors' knowledge, this is the first study to provide national estimates of medical expenditures for all adult cancer survivors aged <65 years. Most studies of expenditures for cancer survivors in this age group have been based on the Medical Expenditure Panel Survey (MEPS) and were limited to "affected survivors."
MEPS expenditure data for 2001 to 2007 were linked to data identifying all survivors from the National Health Interview Survey (NHIS), which is the MEPS sampling frame. The sample was comprised of adults ages 25 to 64 years. Propensity-score matching was used to estimate the effects of cancer on average total and out-of-pocket expenditures for all services and separately for prescriptions. Probit models were used to estimate effects on the probability of exceeding different expenditure thresholds.
Mean annual expenditures on all services in 2007 were $16,910 ± $3911 for survivors who were newly diagnosed with cancer, $7992 ± $972 for survivors who had been diagnosed in previous years, and $3303 ± $103 for other adults. Fifty-three percent of survivors were not identified in MEPS but only by linking to NHIS. Expenditures for all survivors averaged approximately $9300 compared with $13,600 for "affected survivors." For previously diagnosed survivors, the increase in mean expenditures attributable to cancer was approximately $4000 to $5000 annually. On average, relatively little of the increase was paid out of pocket, but cancer nearly doubled the risk of high out-of-pocket expenditures.
Previous MEPS analyses overstated average expenditures for all survivors. Nevertheless, the current results indicated that the increase in expenditures attributable to cancer is substantial, even for longer term survivors, and that cancer increases the relative risk of high out-of-pocket expenditures.
据作者所知，这是第一项提供所有 <65 岁成年癌症幸存者的医疗支出国家估计的研究。该年龄组癌症幸存者支出的大多数研究都基于医疗支出面板调查 (MEPS)，并且仅限于“受影响的幸存者”。
将 2001 年至 2007 年的 MEPS 支出数据与从全国健康访谈调查 (NHIS) 中确定所有幸存者的数据进行链接，NHIS 是 MEPS 的抽样框架。该样本由 25 至 64 岁的成年人组成。使用倾向评分匹配来估计癌症对所有服务的平均总支出和自付支出的影响，并分别对处方进行估计。使用概率模型来估计超过不同支出阈值的概率的影响。
2007 年，新诊断癌症的幸存者的所有服务的年平均支出为 16910 美元±3911 美元，以前诊断过癌症的幸存者的支出为 7992 美元±972 美元，其他成年人的支出为 3303 美元±103 美元。只有通过链接到 NHIS，53%的幸存者才在 MEPS 中被识别。与“受影响的幸存者”相比，所有幸存者的支出平均约为 9300 美元。对于以前诊断过的幸存者，归因于癌症的平均支出增加约为每年 4000 至 5000 美元。平均而言，自付支出增加的相对较少，但癌症使自付支出过高的风险几乎增加了一倍。
之前的 MEPS 分析夸大了所有幸存者的平均支出。尽管如此，目前的结果表明，归因于癌症的支出增加是可观的，即使对于长期幸存者也是如此，而且癌症增加了自付支出过高的相对风险。
