%0 Journal Article %J Value Health %D 2004 %T Out-of-pocket health-care expenditures among older Americans with cancer. %A Kenneth M. Langa %A A. Mark Fendrick %A M.E. Chernew %A Mohammed U Kabeto %A Paisley, Kerry L. %A Hayman, James A. %K Aged %K Aged, 80 and over %K Cost of Illness %K Family Characteristics %K Female %K Financing, Personal %K Health Expenditures %K Health Services Research %K Humans %K Insurance, Health %K Longitudinal Studies %K Male %K Medicaid %K Medicare %K Michigan %K Neoplasms %X

OBJECTIVE: There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx).

METHODS: We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated.

RESULTS: Of the 6370 respondents, 5382 (84%) reported No CA, 812 (13%) reported CA/No Tx, and 176 (3%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were 1210 dollars, 1450 dollars, and 1880 dollars, respectively (P < .01). Prescription medications (1120 dollars per year) and home care services (250 dollars) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27% of their yearly income on OOPE compared to only 5% of yearly income for high-income individuals with no cancer history (P < .01).

CONCLUSIONS: Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer.

%B Value Health %I 7 %V 7 %P 186-94 %8 2004 Mar-Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/15164808?dopt=Abstract %4 Health Care Costs/Health Expenditures %$ 11532 %R 10.1111/j.1524-4733.2004.72334.x %0 Journal Article %J J Clin Oncol %D 2001 %T Estimating the cost of informal caregiving for elderly patients with cancer. %A Hayman, James A. %A Kenneth M. Langa %A Mohammed U Kabeto %A Steven J. Katz %A DeMonner, Sonya M. %A M.E. Chernew %A Slavin, Mitchell B. %A A. Mark Fendrick %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Family %K Female %K Home Nursing %K Humans %K Male %K Multivariate Analysis %K Neoplasms %K Regression Analysis %K United States %X

PURPOSE: As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients.

MATERIALS AND METHODS: To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT).

RESULTS: Of the 7,443 subjects surveyed, 6,422 (86%) reported NC, 718 (10%) reported CNT, and 303 (4%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26%, it was 34% for those reporting CT (P <.05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P <.05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally.

CONCLUSION: Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly.

%B J Clin Oncol %I 19 %V 19 %P 3219-25 %8 2001 Jul 01 %G eng %N 13 %L pubs_2001_Hayman_JJClinOnc.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11432889?dopt=Abstract %4 Activities of Daily Living/Aged, 80 and Over/Caregivers/Cost of Illness/Family/Psychology/Female/Home Nursing/Economics/Statistics and Numerical Data/Human/Multivariate Analysis/Neoplasms/Complications/Therapy/Regression Analysis/United States %$ 4250 %R 10.1200/JCO.2001.19.13.3219