Trends in Healthcare Expenditures among Adults in the United States by Cancer Diagnosis Status, 2008–2016: A Cross-Sectional Study

BACKGROUND: This study aims to assess trends in direct medical expenditures and indirect costs between adults with and without a prior cancer diagnosis from 2008 to 2016. METHODS: Nine years of data (2008–2016) from the Medical Expenditure Panel Survey (weighted N = 236,811,875) were used. The outcomes included medical expenditures (total expenditure, inpatient, office-based, medications, outpatient, dental, emergency room visits, home health, other) and health-related missed workdays. The predictor was prior cancer diagnosis. Covariates included demographic characteristics, comorbidities, and calendar year at time of survey completion. Two-part statistical modeling with a combination of binomial and positive distributions was used to estimate medical expenditures and missed workdays. Data were clustered into five timepoints: 2008 to 2009, 2010 to 2011, 2012 to 2013, 2014 to 2015, and 2016. RESULTS: Eleven percent of the sample (n = 25,005,230) had a prior cancer diagnosis. Compared with those without a prior cancer diagnosis, those with a prior cancer diagnosis had higher mean incremental total expenditures across all years. Between 2008 and 2016, the adjusted annual incremental total expenditures were $3,522 [95% confidence interval (CI), $3,072–$3,972]; office-based visits ($1,085; 95% CI, $990–$1180); inpatient hospitalizations ($810; 95% CI, $627–$992); outpatient appointments ($517; 95% CI, $434–$600); and medications ($409; 95% CI, $295–$523); and health-related missed workdays (0.75; 95% CI, 0.45–1.04) compared with adults without a prior cancer diagnosis. CONCLUSIONS: Adults with a prior cancer diagnosis had significantly increased healthcare expenditures and health-related missed workdays compared with those with no cancer diagnosis. IMPACT: Our findings highlight the need for increasing strategies to remedy the impact of increasing direct and indirect costs associated with cancer survivorship as the population grows and ages.