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Karim MA, Ramezani M, Leroux T, Kum HC, Singal AG. Healthcare Costs for Medicare Patients With Hepatocellular Carcinoma in the United States. Clin Gastroenterol Hepatol 2023; 21:2327-2337.e9. [PMID: 36435358 PMCID: PMC10205916 DOI: 10.1016/j.cgh.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/12/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) has an increasing mortality in the United States and is a leading cause of morbidity and mortality in patients with cirrhosis. We aimed to estimate the financial burden related to HCC in a large nationally representative United States cohort. METHODS We used the Surveillance, Epidemiology, and End Results program (SEER)-Medicare database to identify 4525 adult patients who were diagnosed with HCC between 2011 and 2015. We generated a 1:1 propensity score-matched cohort of patients with cirrhosis but no HCC as a comparator group to define incremental HCC-specific costs beyond costs related to underlying cirrhosis. Our main outcomes were patient liabilities and Medicare payments in the first year after HCC diagnosis. RESULTS Compared with patients with cirrhosis, those with HCC had higher incremental patient liabilities (median +$7166; interquartile range, $2401-$16,099) and Medicare payments (+$50,110; interquartile range, $142,42-$136,239; P < .001 for both) in the first year after diagnosis. Patients with HCC had significantly higher inpatient, outpatient, and physician service costs compared with the matched cohort with cirrhosis (P < .001 for all). Patients with early-stage HCC had lower incremental patient liabilities (median, $4195 vs $8238; P < .001) and Medicare payments (median, $28,207 vs $59,509; P < .001) than those with larger tumor burden. In multivariable median regression analysis, incremental patient liabilities and Medicare payments were significantly associated with the National Cancer Institute comorbidity index, nonalcoholic fatty liver disease etiology, presence of ascites, and presence of hepatic encephalopathy. CONCLUSIONS Patients with HCC suffer from cancer-related financial burden, highlighting a need for policy interventions and financial support systems.
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Affiliation(s)
- Mohammad A Karim
- Population Informatics Laboratory, Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Mahin Ramezani
- Population Informatics Laboratory, Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, Texas
| | | | - Hye-Chung Kum
- Population Informatics Laboratory, Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Amit G Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
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Christodoulou I, Ukert B, Vavuranakis MA, Kum HC, Giannouchos TV. Adult Cancer-Related Emergency Department Utilization: An Analysis of Trends and Outcomes From Emergency Departments in Maryland and New York. JCO Oncol Pract 2023; 19:e683-e695. [PMID: 36827627 DOI: 10.1200/op.22.00525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To explore emergency department (ED) visits by adults with cancer and to estimate associations between inpatient admissions through the ED and mortality with sociodemographic and clinical factors within this cohort. METHODS We conducted a retrospective, pooled, cross-sectional analysis of the Healthcare Cost and Utilization State Emergency Department Databases and State Inpatient Databases for Maryland and New York from January 2013 to December 2017. We examined inpatient admissions through the ED and mortality using frequencies. Among patients with cancer, multivariable regressions were used to estimate sociodemographic and clinical factors associated with inpatient admissions and outpatient ED and inpatient mortality overall. RESULTS Among 22.7 million adult ED users, 1.3 million (5.7%) had at least one cancer-related diagnosis. ED visit rates per 100,000 population increased annually throughout the study period for patients with cancer and were 9.9% higher in 2017 compared with 2013 (2013: 303.5; 2017: 333.6). Having at least one inpatient admission (68.7% v 20.5%; P < .001) and inpatient or ED mortality (6.5% v 1.0%; P < .001) were higher among ED users with cancer compared with those without. Among patients with cancer, being uninsured (adjusted odds ratio, 0.52; 95% CI, 0.44 to 0.62) compared with having Medicare coverage and non-Hispanic Black (adjusted odds ratio, 0.86; 95% CI, 0.80 to 0.92) compared with non-Hispanic White were associated with decreased odds of inpatient admissions. In contrast, patients with cancer without health insurance, non-Hispanic Black patients, and residents of nonlarge metropolitan areas and of areas with lower household incomes had increased odds of mortality. CONCLUSION High inpatient admissions through the ED and mortality among adult patients with cancer, coupled with an increase in cancer-related ED visit rates and observed disparities in outcomes, highlight the need to improve access to oncologic services to contain ED use and improve care for patients with cancer.
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Affiliation(s)
- Ilias Christodoulou
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.,The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benjamin Ukert
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX
| | | | - Hye-Chung Kum
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX
| | - Theodoros V Giannouchos
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Robien K, Clausen M, Sullo E, Ford YR, Griffith KA, Le D, Wickersham KE, Wallington SF. Prevalence of Food Insecurity Among Cancer Survivors in the United States: A Scoping Review. J Acad Nutr Diet 2023; 123:330-346. [PMID: 35840079 DOI: 10.1016/j.jand.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Medical financial hardship is an increasingly common consequence of cancer treatment and can lead to food insecurity. However, food security status is not routinely assessed in the health care setting, and the prevalence of food insecurity among cancer survivors is unknown. OBJECTIVE This scoping review aimed to identify the prevalence of food insecurity among cancer survivors in the United States before the COVID-19 pandemic. METHODS Five databases (PubMed, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ProQuest Dissertations and Theses) were systematically searched for articles that reported on food security status among US patients receiving active cancer treatment or longer-term cancer survivors and were published between January 2015 and December 2020. RESULTS Among the 15 articles meeting the inclusion criteria, overall food insecurity prevalence ranged from 4.0% among women presenting to a gynecologic oncology clinic to 83.6% among patients at Federally Qualified Health Centers. Excluding studies focused specifically on Federally Qualified Health Center patients, prevalence of food insecurity ranged from 4.0% to 26.2%, which overlaps the food insecurity prevalence in the general US population during the same time period (range, 10.5% to 14.9%). Women were more likely than men to report being food insecure, and the prevalence of food insecurity was higher among Hispanic and Black patients compared with non-Hispanic White patients. CONCLUSIONS Given significant heterogeneity in study populations and sample sizes, it was not possible to estimate an overall food insecurity prevalence among cancer survivors in the United States. Routine surveillance of food security status and other social determinants of health is needed to better detect and address these issues.
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Affiliation(s)
- Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC; GW Cancer Center, George Washington University, Washington, DC.
| | | | - Elaine Sullo
- Himmelfarb Health Sciences Library, George Washington University, Washington, DC
| | - Yvonne R Ford
- School of Nursing, North Carolina A&T State University, Greensboro, NC
| | - Kathleen A Griffith
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
| | - Daisy Le
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
| | | | - Sherrie Flynt Wallington
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
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Karim MA, Talluri R, Shastri SS, Kum HC, Shete S. Financial Toxicities Persist for Cancer Survivors Irrespective of Current Cancer Status: An Analysis of Medical Expenditure Panel Survey. CANCER RESEARCH COMMUNICATIONS 2022; 2:1119-1128. [PMID: 36531523 PMCID: PMC9757609 DOI: 10.1158/2767-9764.crc-22-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study estimates the out-of-pocket (OOP) expenditures for different cancer types among survivors with current vs no current cancer condition and across sex, which is understudied in the literature. This is a cross-sectional study of Medical Expenditure Panel Survey data for 2009-2018 where the primary outcome was the average per year OOP expenditure incurred by cancer survivors. Of 189 285 respondents, 15 010 (7.93%) were cancer survivors; among them, 46.28% had a current cancer condition. Average per year OOP expenditure for female survivors with a current condition of breast cancer ($1730), lung cancer ($1679), colon cancer ($1595), melanoma ($1783), non-Hodgkin lymphoma ($1656), nonmelanoma/other skin cancer (NMSC, $2118) and two or more cancers ($2310) were significantly higher than that of women with no history of cancer ($853, all P < .05). Similarly, average per year OOP expenditure for male survivors with a current condition of prostate cancer ($1457), lung cancer ($1131), colon cancer ($1471), melanoma ($1474), non-Hodgkin's lymphoma ($1653), NMSC ($1789), and bladder cancer ($2157) were significantly higher compared with the men with no history of cancer ($621, all P < .05). These differences persisted in survivors with no current cancer condition for breast cancer among women; prostate, lung, colon, and bladder cancer among men; and melanoma, NMSC, and two or more cancers among both sexes. OOP expenditure varied across cancer types and by sex for survivors with and without a current cancer condition. These findings highlight the need for targeted interventions for cancer survivors.
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Affiliation(s)
- Mohammad A. Karim
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Population Informatics Lab, Texas A&M University, College Station, Texas
| | - Rajesh Talluri
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Surendra S. Shastri
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hye-Chung Kum
- Population Informatics Lab, Texas A&M University, College Station, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Corresponding Author: Sanjay Shete, Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, 1400 Pressler Dr, FCT4.6002, Houston, TX 77030. Phone: (713) 745-2483; E-mail:
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Karim MA, Singal AG, Ohsfeldt RL, Morrisey MA, Kum HC. Health services utilization, out-of-pocket expenditure, and underinsurance among insured non-elderly cancer survivors in the United States, 2011-2015. Cancer Med 2021; 10:5513-5523. [PMID: 34327859 PMCID: PMC8366084 DOI: 10.1002/cam4.4103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High out-of-pocket (OOP) expenditure and inadequate insurance coverage may adversely affect cancer survivors. We aimed to characterize the extent and correlates of healthcare utilization, OOP expenditures, and underinsurance among insured cancer survivors. METHODS We used 2011-2015 Medical Expenditure Panel Survey data to identify a nationally representative sample of insured non-elderly adult (age 18-64 years) cancer survivors. We used negative binomial, two-part (logistic and Generalized Linear Model with log link and gamma distribution), and logistic regression models to quantify healthcare utilization, OOP expenditures, and underinsurance, respectively, and identified sociodemographic correlates for each outcome. RESULTS We identified 2738 insured non-elderly cancer survivors. Adjusted average utilization of ambulatory, non-ambulatory, prescription medication, and dental services was 14.4, 0.51, 24.9, and 1.4 events per person per year, respectively. Higher ambulatory and dental services utilization were observed in older adults, females, non-Hispanic Whites, survivors with a college degree and high income, compared to their counterparts. Nearly all (97.7%) survivors had some OOP expenditures, with a mean adjusted OOP expenditure of $1552 per person per year. Adjusted mean OOP expenditures for ambulatory, non-ambulatory, prescription medication, dental, and other health services were $653, $161, $428, $194, and $83, respectively. Sociodemographic variations in service-specific OOP expenditures were generally consistent with respective utilization patterns. Overall, 8.8% of the survivors were underinsured. CONCLUSION Many insured non-elderly cancer survivors allocate a substantial portion of their OOP expenditure for healthcare-related services and experience financial vulnerability, resulting in nearly 8.8% of the survivors being underinsured. Utilization of healthcare services varies across sociodemographic groups.
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Affiliation(s)
- Mohammad A Karim
- Population Informatics Laboratory, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert L Ohsfeldt
- Population Informatics Laboratory, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Michael A Morrisey
- Population Informatics Laboratory, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Hye-Chung Kum
- Population Informatics Laboratory, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
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