Healthcare Outcomes Presented at the Academic Surgical Congress 2020| Volume 167, ISSUE 6, P985-990, June 2020

Health expenditures and financial burden among patients with major gastrointestinal cancers relative to other common cancers in the United States

Published:April 15, 2020DOI:



      Gastrointestinal cancers contribute substantially to the cost of health care. We sought to quantify and compare the financial burden associated with treatment of gastrointestinal cancers versus other common nongastrointestinal cancers.


      The Medical Expenditure Panel Survey from 2006 to 2015 was used to identify individuals with gastrointestinal cancer, other nongastrointestinal cancer (breast/prostate or lung), or no history of malignancy. Total and out-of-pocket medical expenditures were compared. Among each cohort, risk of high and catastrophic financial burden was determined.


      A total of 90,344 individuals were identified, which was extrapolated to a national representative sample of 95,449,062 individuals. Overall, an estimated 365,367 (0.4%) individuals had a gastrointestinal cancer while 2,015,724 (2.1%) had lung, breast, or prostate cancer. Mean adjusted total health expenditures was greater among patients with gastrointestinal cancer ($13,716; 95% confidence interval, $9,805–$17,628) versus patients with nongastrointestinal cancer ($8,665; 95% confidence interval, $8,222–$9,108) or individuals without cancer ($5,807; 95% confidence interval $5,740–$5,874). An estimated 15.8% (n = 57,898) and 7.1% (n = 25,956) of patients with gastrointestinal cancer experienced a high and catastrophic financial burden, respectively. Patients with gastrointestinal cancer had a 64% increased odds of experiencing catastrophic financial burden compared with patients without a history of cancer (odds ratio 1.64, 95% confidence interval, 1.17–2.31). Furthermore, patients with a gastrointestinal cancer had nearly 40% increased odds of high financial burden associated with their care compared with patients without cancer (odds ratio 1.37; 95% confidence interval, 1.00–1.88).


      The risk of experiencing catastrophic financial burden among patients with gastrointestinal cancer was considerable, as roughly 1 in 7 patients experienced high financial burden, and 1 in 13 had a catastrophic financial burden.
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        • Fitzmaurice C.
        • Dicker D.
        • Pain A.
        • et al.
        The global burden of cancer 2013.
        JAMA Oncol. 2015; 1: 505-527
        • Peery A.F.
        • Crockett S.D.
        • Murphy C.C.
        • et al.
        Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018.
        Gastroenterology. 2019; 156: 254-272.e211
      1. National Cancer Institute: Cancer trends progress report: Financial burden of cancer care. Accessed July 3, 2019.

        • Tangka F.K.
        • Trogdon J.G.
        • Richardson L.C.
        • Howard D.
        • Sabatino S.A.
        • Finkelstein E.A.
        Cancer treatment cost in the United States: has the burden shifted over time?.
        Cancer. 2010; 116: 3477-3484
        • Khera R.
        • Valero-Elizondo J.
        • Okunrintemi V.
        • et al.
        Association of out-of-pocket annual health expenditures with financial hardship in low-income adults with atherosclerotic cardiovascular disease in the United States.
        JAMA Cardiol. 2018; 3: 729-738
        • Langa K.M.
        • Fendrick A.M.
        • Chernew M.E.
        • et al.
        Out-of-pocket health-care expenditures among older Americans with cancer.
        Value Health. 2004; 7: 186-194
      2. Himmelstein DU, Warren E, Thorne D, Woolhandler S. Illness and injury as contributors to bankruptcy. Health Aff (Millwood). 2005;(Suppl Web Exclusives):W5-63-W65-73.

        • Catlin M.K.
        • Poisal J.A.
        • Cowan C.A.
        Out-of-pocket health care expenditures, by insurance status, 2007-10.
        Health Aff (Millwood). 2015; 34: 111-116
        • Massa S.T.
        • Osazuwa-Peters N.
        • Adjei Boakye E.
        • Walker R.J.
        • Ward G.M.
        Comparison of the financial burden of survivors of head and neck cancer with other cancer survivors.
        JAMA Otolaryngol Head Neck Surg. 2019; 145: 239-249
        • Kale H.P.
        • Carroll N.V.
        Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors.
        Cancer. 2016; 122: 283-289
      3. Medical expenditure panel survey homepage. Accessed June 24, 2019.

      4. Medical expenditure panel survey clinical classification code to ICD-9-CM Code Crosswalk. Accessed June 24, 2019.

        • DeSantis C.E.
        • Lin C.C.
        • Mariotto A.B.
        • et al.
        Cancer treatment and survivorship statistics, 2014.
        CA Cancer J Clin. 2014; 64: 252-271
      5. Bureau of Labor Statistics Consumer Price Index. Accessed June 26, 2019.

        • Xu K.
        • Evans D.B.
        • Kawabata K.
        • Zeramdini R.
        • Klavus J.
        • Murray C.J.
        Household catastrophic health expenditure: a multicountry analysis.
        Lancet. 2003; 362: 111-117
        • Basu A.
        • Manning W.G.
        • Mullahy J.
        Comparing alternative models: log vs Cox proportional hazard?.
        Health Econ. 2004; 13: 749-765
        • Hedeker D.R.
        • Gibbons R.D.
        Longitudinal Data Analysis.
        Wiley-Interscience, Hoboken, NJ2006
        • Hyer J.M.
        • Ejaz A.
        • Diaz A.
        • et al.
        Characterizing and assessing the impact of surgery on healthcare spending among medicare enrolled preoperative super-utilizers.
        Ann Surg. 2019; 270: 554-563
        • Malehi A.S.
        • Pourmotahari F.
        • Angali K.A.
        Statistical models for the analysis of skewed healthcare cost data: a simulation study.
        Health Econ Rev. 2015; 5: 11
      6. Survey: analysis of complex survey samples [computer program]. 2019.

        • Quality AfHRa
        MEPS-HC summary data tables technical notes. 2013.
        • Nipp R.D.
        • Sonet E.M.
        • Guy G.P.
        Communicating the financial burden of treatment with patients.
        Am Soc Clin Oncol Educ Book. 2018; 38: 524-531
        • Mariotto A.B.
        • Yabroff K.R.
        • Shao Y.
        • Feuer E.J.
        • Brown M.L.
        Projections of the cost of cancer care in the United States: 2010-2020.
        J Natl Cancer Inst. 2011; 103: 117-128
        • Fenn K.M.
        • Evans S.B.
        • McCorkle R.
        • et al.
        Impact of financial burden of cancer on survivors' quality of life.
        J Oncol Pract. 2014; 10: 332-338
        • Hastert T.A.
        • Young G.S.
        • Pennell M.L.
        • et al.
        Financial burden among older, long-term cancer survivors: results from the LILAC study.
        Cancer Med. 2018; 7: 4261-4272
        • Nipp R.D.
        • Kirchhoff A.C.
        • Fair D.
        • et al.
        Financial burden in survivors of childhood cancer: a report from the childhood cancer survivor study.
        J Clin Oncol. 2017; 35: 3474-3481
        • Warren J.L.
        • Yabroff K.R.
        • Meekins A.
        • et al.
        Evaluation of trends in the cost of initial cancer treatment.
        J Natl Cancer Inst. 2008; 100: 888-897
        • Cerullo M.
        • Gani F.
        • Chen S.Y.
        • et al.
        Assessing the financial burden associated with treatment options for resectable pancreatic cancer.
        Ann Surg. 2018; 267: 544-551
        • Ekwueme D.U.
        • Trogdon J.G.
        • Khavjou O.A.
        • Guy Jr., G.P.
        Productivity costs associated with breast cancer among survivors aged 18-44 years.
        Am J Prev Med. 2016; 50: 286-294
        • Warner E.L.
        • Kirchhoff A.C.
        • Nam G.E.
        • Fluchel M.
        Financial burden of pediatric cancer for patients and their families.
        J Oncol Pract. 2015; 11: 12-18
        • Jemal A.
        • Lin C.C.
        • Davidoff A.J.
        • Han X.
        Changes in insurance coverage and stage at diagnosis among nonelderly patients with cancer after the affordable care act.
        J Clin Oncol. 2017; 35: 3906-3915
        • Alcala H.E.
        • Chen J.
        • Langellier B.A.
        • Roby D.H.
        • Ortega A.N.
        Impact of the affordable care act on health care access and utilization among Latinos.
        J Am Board Fam Med. 2017; 30: 52-62
        • Sommers B.D.
        • Gunja M.Z.
        • Finegold K.
        • Musco T.
        Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act.
        JAMA. 2015; 314: 366-374
        • Hong Y.R.
        • Smith G.L.
        • Xie Z.
        • Mainous 3rd, A.G.
        • Huo J.
        Financial burden of cancer care under the Affordable Care Act: analysis of MEPS-experiences with cancer survivorship 2011 and 2016.
        J Cancer Surviv. 2019; 13: 523-536
        • Goldman A.L.
        • Woolhandler S.
        • Himmelstein D.U.
        • Bor D.H.
        • McCormick D.
        Out-of-pocket spending and premium contributions after implementation of the Affordable Care Act.
        JAMA Intern Med. 2018; 178: 347-355