Bhattacharjee Sandipan, Khobrani Moteb, Alrabiah Ziyad, Bilal Jawad, Riaz Irbaz Bin
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
Health Outcomes & PharmacoEconomic Research (HOPE) Center, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
Heliyon. 2019 Jun 24;5(6):e01995. doi: 10.1016/j.heliyon.2019.e01995. eCollection 2019 Jun.
This 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.
A 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.
The 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%).
Our 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.
本研究评估了美国社区居住的甲状腺癌成年患者与非癌症对照相比的额外医疗支出及其相关因素。
采用回顾性横断面匹配病例对照研究设计，汇总多年的医疗支出面板调查（MEPS）数据（2002 - 2012年）。符合条件的研究样本包括在日历年期间存活且报告有正医疗支出的成年人（年龄≥18岁）。病例组仅包括患有甲状腺癌的成年人，而对照组包括没有任何形式癌症的成年人。年平均医疗支出的总和及亚型构成主要研究结果。我们还计算了自付费用（OOP）的总和及亚型以及OOP占家庭收入的百分比。对经对数转换的支出进行普通最小二乘法（OLS）回归，以阐明不同因素对甲状腺癌成年患者医疗支出的影响。
与倾向得分匹配的对照组相比，甲状腺癌成年患者的年平均总医疗支出显著更高（9585美元对5830美元，p < 0.001）。在住院和门诊支出方面也有类似观察结果。功能状态以及合并症与额外支出显著相关。与匹配的对照组相比，甲状腺癌成年患者的年平均总OOP支出显著更高（1425美元对974美元，p < 0.001），在住院OOP（178美元对24美元，p = 0.003）、门诊OOP（435美元对256美元，p < 0.001）和处方OOP（554美元对423美元，p < 0.001）支出方面观察到主要差异。甲状腺癌成年患者（均值：7.54%，标准误：1.52%）与匹配对照组（均值：5.80%，标准误：0.47%）之间，OOP占家庭收入的平均百分比存在显著差异（p < 0.001）。
我们的研究结果表明，整体护理方法可能有助于显著减轻该人群的经济负担。需要诸如限制OOP成本等可行策略，以尽量减少癌症幸存者及其家庭的这种高OOP负担。
