Impact of Functional Disability on Healthcare Use and Medical Costs among Cancer Survivors
Hyo Jung Tak, Ronnie D Horner, Min Sok Lee, Ya-Chen Tina Shih- Cancer Research
- Oncology
Abstract
Background
Cancer survivors with a disability are among the most vulnerable in health status and financial hardship, but no prior research has systematically examined how disability modifies healthcare use and costs. This study examines the association of functional disability among cancer survivors with their healthcare utilization and medical costs.
Methods
We generated nationally representative estimates using the 2015-2019 Medical Expenditure Panel Survey. Outcomes included utilization of six service types (inpatient, outpatient, office-based physician, office-based non-physician, ED, prescription) and medical costs of aggregate services and by each of six service types. Primary independent variable was a categorical variable of total number of functional disabilities. We employed multivariable generalized linear models and two-part models, adjusting for socio-demographics and health conditions and accounting for survey design.
Results
Among cancer survivors (n = 9,359; weighted n = 21,046,285), 38.8% reported at least one disability. Compared to those without disability, cancer survivors with ≥4 disabilities experienced longer hospital stays (adjusted average marginal effect [AME] 1.14 days; 95% confidence interval [CI] 0.55-1.73), more visits to office-based physician (AME 1.43 visits; 95% CI 0.51-2.35), and greater number of prescriptions (AME 12.1 prescriptions; 95% CI 9.27-15.0). Their total (AME $9,537; 95% CI $5,713-$13,361) and out-of-pocket (AME $639; 95% CI $79-$1,199) medical costs for aggregate services were significantly higher. By type, disability in independent living was most strongly associated with greater costs for aggregate services.
Conclusions
Cancer survivors with a disability experienced greater healthcare use and higher costs. Cancer survivorship planning for healthcare and financial stability should consider the patients’ disability profile.