title: Economic burden of cancer survivorship among adults in the United States.
abstract: OBJECTIVE
  To present nationally representative estimates of the impact of cancer survivorship on medical expenditures and lost productivity among adults in the United States.
  
  
  METHODS
  Using the 2008 to 2010 Medical Expenditure Panel Survey, we identified 4,960 cancer survivors and 64,431 individuals without a history of cancer age ≥ 18 years. Direct medical costs were measured using annual health care expenditures and examined by source of payment and service type. Indirect morbidity costs were estimated from lost productivity as a result of employment disability, missed work days, and lost household productivity. We evaluated the economic burden of cancer survivorship by estimating excess costs among cancer survivors, stratified by time since diagnosis (recently diagnosed [≤ 1 year] and previously diagnosed [> 1 year]), compared with individuals without a history of cancer using multivariable regression models stratified by age (18 to 64 and ≥ 65 years), controlling for age, sex, race/ethnicity, education, and comorbidities.
  
  
  RESULTS
  In 2008 to 2010, the annual excess economic burden of cancer survivorship among recently diagnosed cancer survivors was $16,213 per survivor age 18 to 64 years and $16,441 per survivor age ≥ 65 years. Among previously diagnosed cancer survivors, the annual excess burden was $4,427 per survivor age 18 to 64 years and $4,519 per survivor age ≥ 65 years. Excess medical expenditures composed the largest share of the economic burden among cancer survivors, particularly among those recently diagnosed.
  
  
  CONCLUSIONS
  The economic impact of cancer survivorship is considerable and is also high years after a cancer diagnosis. Efforts to reduce the economic burden caused by cancer will be increasingly important given the growing population of cancer survivors.
authors.affiliation: Gery P. Guy Jr, Donatus U. Ekwueme, Chunyu Li, and Juan L. Rodriguez, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Katherine S. Virgo, Rollins School of Public Health, Emory University, Atlanta, GA; K. Robin Yabroff and Janet S. de Moor, National Cancer Institute, Bethesda, MD; and Emily C. Dowling, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.
authors.forename: Gery P
authors.initials: GP
authors.lastname: Guy
authors.forename: Donatus U
authors.initials: DU
authors.lastname: Ekwueme
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.forename: Emily C
authors.initials: EC
authors.lastname: Dowling
authors.forename: Chunyu
authors.initials: C
authors.lastname: Li
authors.forename: Juan L
authors.initials: JL
authors.lastname: Rodriguez
authors.forename: Janet S
authors.initials: JS
authors.lastname: de Moor
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Virgo
mesh_terms: D000041:Absenteeism; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D017281:Cost of Illness; D006233:Persons with Disabilities; D004526:Efficiency; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009369:Neoplasms / Q000191:economics*; D017741:Survivors / Q000706:statistics & numerical data; D014481:United States
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