title: Annual Medical Expenditure and Productivity Loss Among Colorectal, Female Breast, and Prostate Cancer Survivors in the United States.
abstract: BACKGROUND
  There are limited nationally representative estimates of the annual economic burden among survivors of the three most prevalent cancers (colorectal, female breast, and prostate) in both nonelderly and elderly populations in the United States.
  
  
  METHODS
  The 2008 to 2012 Medical Expenditure Panel Survey data were used to identify colorectal (n = 540), female breast (n = 1568), and prostate (n = 1170) cancer survivors and individuals without a cancer history (n = 109 423). Excess economic burden attributable to cancer included per-person excess annual medical expenditures and productivity losses (employment disability, missed work days, and days stayed in bed). All analyses were stratified by cancer site and age (nonelderly: 18-64 years vs elderly: ≥ 65 years). Multivariable analyses controlled for age, sex, race/ethnicity, marital status, education, number of comorbidities, and geographic region. All statistical tests were two-sided.
  
  
  RESULTS
  Compared with individuals without a cancer history, cancer survivors experienced annual excess medical expenditures (for the nonelderly population, colorectal: $8647, 95% confidence interval [CI] = $4932 to $13 974, P < .001; breast: $5119, 95% CI = $3439 to $7158, P < .001; prostate: $3586, 95% CI = $1792 to $6076, P < .001; for the elderly population, colorectal: $4913, 95% CI = $2768 to $7470, P < .001; breast: $2288, 95% CI = $814 to $3995, P = .002; prostate: $3524, 95% CI = $1539 to $5909, P < .001). Nonelderly colorectal and breast cancer survivors experienced statistically significant annual excess employment disability (13.6%, P < .001, and 4.8%, P = .001) and productivity loss at work (7.2 days, P < .001, and 3.3 days, P = .002) and at home (4.5 days, P < .001, and 3.3 days, P = .003). In contrast, elderly survivors of all three cancer sites had comparable productivity losses as those without a cancer history.
  
  
  CONCLUSIONS
  Colorectal, breast, and prostate cancer survivors experienced statistically significantly higher economic burden compared with individuals without a cancer history; however, excess economic burden varies by cancer site and age. Targeted efforts will be important in reducing the economic burden of colorectal, breast, and prostate cancer.
authors.affiliation: Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB).
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB).
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.affiliation: Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB).
authors.forename: Gery P
authors.initials: GP
authors.lastname: Guy
authors.affiliation: Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB).
authors.forename: Xuesong
authors.initials: X
authors.lastname: Han
authors.affiliation: Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB).
authors.forename: Chunyu
authors.initials: C
authors.lastname: Li
authors.affiliation: Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB).
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Banegas
authors.affiliation: Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB).
authors.forename: Donatus U
authors.initials: DU
authors.lastname: Ekwueme
authors.affiliation: Affiliations of authors:Surveillance and Health Services Research Program, American Cancer Society , Atlanta, GA (ZZ, XH, AJ); Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda, MD (KRY); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, GA (GPGJr, CL, DUE); The Center for Health Research, Kaiser Permanente , Portland, OR (MPB).
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics*; D015179:Colorectal Neoplasms / Q000191:economics*; D017281:Cost of Illness; D004526:Efficiency; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000191:economics*; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States; D014937:Work / Q000706:statistics & numerical data