Economic burden attributable to healthcare-associated infections at western China hospitals: 6 Year, prospective cohort study.

OBJECTIVES: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. METHODS: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. RESULTS: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084). CONCLUSIONS: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.

The role of innovation and entrepreneurship in promoting common prosperity in China: Empirical evidence from a two-way fixed effects model.

Common prosperity stands as a pivotal concept and objective within China's socialism with distinctive characteristics, serving as a fundamental assurance and basis for ensuring its people's happiness and comprehensive development. This research employs a Coupled Coordination Degree Model to construct a common prosperity Index using data from China between 2010 and 2020. The study investigates the influence of innovation and entrepreneurship on common prosperity while examining the regulating roles played by the government and market during this process. The outcomes demonstrate that innovation substantially facilitates the realization of common prosperity. The relationship between entrepreneurship and common prosperity follows a positive "U"-shaped curve, where entrepreneurship significantly contributes to common prosperity upon reaching a particular scale. Further investigations reveal heterogeneity in the impact of innovation and entrepreneurship on common prosperity. Specifically, innovation significantly contributes to common prosperity in the northern regions, whereas entrepreneurship has a noteworthy impact on common prosperity in the southern regions. Moreover, it is worth noting that both innovation and entrepreneurship have a significant influence on common prosperity in areas characterized by low economic development levels and a scarcity of fixed capital. The fiscal effects of the government attenuate the promoting effect of innovation on common prosperity but enhance the adverse influence of entrepreneurship. On the contrary, market mechanisms mitigate the negative impact of entrepreneurship on common prosperity. Consequently, achieving common prosperity requires strengthened regional innovation cooperation, encouraging advanced regions to lead underdeveloped regions, and leveraging the regulatory roles of both the government and the market, thus progressing gradually towards common prosperity.

Energy and air? The impact of energy efficiency improvement on air quality in China.

The global economic growth is hindered by resources shortage, energy demand, air pollution and climate. Energy efficiency can reduce some pollutants while potentially increase others. This study refers to sulfur dioxide (SO2), nitrogen oxides (NOx), and dust and smoke (DS) as primary pollutants to distinguish it from secondary ones. The influence of energy efficiency, socioeconomic, and natural climatic factors on air quality is analyzed under the theory of STIRPAT. It is highly coupled between energy efficiency and the spatial distribution of air quality. Increased energy efficiency can improve air quality by reducing SO2 and NOx, but the impact on DS is insignificant. Air pollutants decrease by about 0.531% for every 1% increase in temperature and 0.105% for every 1% increase in precipitation. Consumption will reduce air pollution, and there is an inverted U-shaped relationship between population density, economic scale, urbanization, technology innovation, and air pollution. It is worth mentioning that this work adds temperature and precipitation to the STIRPAT as natural climatic factors, analyzing the impact of energy efficiency on air pollution under the two-factor restrictions of socioeconomic and natural climatic factors. Finally, management suggestions are made to improve air quality.

Assessment of genetic diversity and population structure of Neocaridina denticulata sinensis in the Baiyangdian drainage area, China, using microsatellite markers and mitochondrial cox1 gene sequences.

Neocaridina denticulata sinensis is a crustacean of major economic significance in the Baiyangdian drainage area. In this study, the first assessment of N. denticulata sinensis genetic diversity and population structure was performed based on sequence analysis of nine polymorphic microsatellite loci and the mitochondrial cytochrome oxidase subunit I (cox1) gene. Samples (n = 192) were collected from four different regions in the Baiyangdian drainage area i.e., Baiyangdian Lake, Jumahe River, Xidayang Reservoir, and Fuhe River. Microsatellite loci analysis identified high levels of genetic diversity represented by observed heterozygosity (Ho) of 0.6865 âˆ¼ 0.9583, expected heterozygosity (He) of 0.7151 âˆ¼ 0.8723, and polymorphism information content (PIC) of 0.6676 âˆ¼ 0.8585. Based on the analysis of cox1 sequences, haplotype diversity (Hd) ranged from 0.568 to 0.853 while nucleotide diversity (π) ranged from 0.0029 to 0.2236. Furthermore, there was no evidence of expansion events in the N. denticulata sinensis populations. Pairwise FST revealed pronounced genetic differentiation, and clustering analyses showed defined genetic structures within the N. denticulata sinensis population. Three groups were identified from four sampled stocks, with Xidayang Reservoir, and Fuhe River populations clustered in the same group. This work identified novel molecular markers and provided an important reference to guide management strategies to assist conservation of N. denticulata sinensis resources.

A High-Precision, Low-Cost, Wireless, Multi-Channel Electrogastrography System.

Electrogastrography (EGG), a method of recording gastric electrical activity, is attractive in both research and clinical applications because of its noninvasive nature. However, the commercially available wireless EGG acquisition system is relatively expensive and the portability is poor. The internal circuit design is unknown, making it difficult to further adjust the system. To overcome these limitations, we have developed a multi-channel EGG acquisition system based on the idea of "low magnification and wide dynamic range". In the system, an analog front end (AFE) including preamplifier, right leg drive (RLD) and low-pass anti-aliasing filter is designed according to the characteristics of the EGG signal, and the high-precision analog-to-digital converter (ADC) is selected for EGG signal collection. The system has the advantages of high precision, low noise, low power consumption, low cost, and high portability. The wireless multi-channel EGG acquisition system can achieve the characteristics of portability and device miniaturization. We provide multiple differential channels for acquisition, which will be helpful to obtain more information about gastric slow wave propagation and coupling.

Cost-effectiveness of pembrolizumab versus docetaxel as second-line treatment of non-small cell lung cancer in China.

BACKGROUND: Pharmacoeconomic information for pembrolizumab as a second-line lung cancer treatment is insufficient in China, so we aimed to assess its cost-effectiveness versus docetaxel as a second-line treatment for patients with non-small cell lung cancer (NSCLC) in China. METHODS: A partitioned survival model was developed to assess the cost-effectiveness of pembrolizumab versus docetaxel in the treatment of NSCLC patients. A phase III clinical trial (KEYNOTE-010) was used as the clinical data. Long-term survival data were extrapolated based on the clinical study data. Lifetime cost and utility were calculated with a discount set at 3%. One-way deterministic sensitivity analyses and probabilistic sensitivity analysis were used to test the robustness of incremental cost-effectiveness ratios (ICER). RESULTS: In the base-case scenario, the ICERs were $107,846/quality-adjusted life year (QALY) and $448,414/QALY for pembrolizumab (2 and 10 mg/kg) groups, respectively. Both ICER values were 3-fold higher than the threshold of China's per-capita GDP in 2019 ($30,055.01). One-way deterministic sensitivity analyses showed that the price of pembrolizumab is the main factor affecting the result of ICER. Median ICERs were $108,658/QALY ($107,005/QALY-$110,089/QALY) for the pembrolizumab 2 mg/kg group and $451,590/QALY ($443,685/QALY-$457,496/QALY) for the pembrolizumab 10 mg/kg group using the current price in China. For patients receiving regimens with 2 mg/kg pembrolizumab, the probabilities will be exceeding 95% when the price of pembrolizumab decreases by 25% in a high-income region (willing to pay setting as $71,406/QALY). CONCLUSIONS: The results suggest that for it to become a second-line treatment of NSCLC in China, a reduction in the cost of pembrolizumab is needed.

[Assessment of caffeine intake in children and adolescents aged 6-17 years in Beijing City].

OBJECTIVE: To assess the intake of caffeine from snacks among children and adolescents aged 6-17 years in Beijing City. METHODS: A multi-stage stratified cluster random sampling method was adopted to obtain the consumption status of caffeine-containing snacks among 881 school-age children and adolescents in Chaoyang, Changping and Yanqing Districts through a 3 d 24 h continuous questionnaire survey between October 2016 and February 2017, and the caffeine content in snacks was obtained through literature retrieval and laboratory detection. RESULTS: The proportion of caffeinated snacks consumers among children and adolescents aged 6-17 years in Beijing was 42. 45%(374/881). The average daily caffeine intake of the whole population was 9. 19 mg, with a median of 0 and a P95 of 41. 38 mg. The average daily caffeine intake of consumers was 21. 66 mg, with a median of 11. 03 mg and 76. 99 mg of P95. About 1. 60%(6/374) of individuals exceeded the daily safe intake level and there were statistically significant differences in caffeine intake between different ages, genders, grades and groups with and without tea drinking habits after weight was taken into account. Among the top three contributors, 12. 13 mg of caffeine was derived from tea, milk tea and tea beverages(including solid drinks), with a contribution rate which reached 56. 01%, 4. 35 mg of caffeine was derived from coffee, with a contribution rate of 20. 09%, and 3. 31 mg of caffeine was derived from cola and energy drinks, with a contribution rate of 15. 30%, and there existed slightly difference of the top three contribution foods among 6-11 and 12-17 years old children and adolescents. CONCLUSION: Children and adolescents aged 6-17 years in Beijing City had low caffeine intake levels from snacks and there was little risk of overconsumption. Tea, milk tea and tea beverages(including solid drinks) was the major contributor to its caffeine exposure.

Medical financial hardship among cancer survivors in the United States.

BACKGROUND: The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States. METHODS: The 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18-49 years [1424 survivors], ages 50-64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18-64 years [66,951 individuals], ages 50-64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18-64 years only). RESULTS: Compared with those without a cancer history, cancer survivors were more likely to report any material (ages 18-49 years: 43.4% vs 30.1%; ages 50-64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18-49 years: 53.5% vs 47.1%), and behavioral (ages 18-49 years: 30.6% vs 21.8%; and ages 50-64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18-49 years and 50-64 years; all P < .01). Among privately insured survivors, having a high-deductible health plan without a health savings account was found to be associated with greater hardship compared with having low-deductible insurance. CONCLUSIONS: Younger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design.

Cost-effectiveness of a patient navigation intervention to increase colonoscopy screening among low-income adults in New Hampshire.

BACKGROUND: Colonoscopy is the most widely used colorectal cancer (CRC) screening test in the United States. Through the detection and removal of potentially precancerous polyps, it can prevent CRC. However, CRC screening remains low among adults who are recommended for screening. The New Hampshire Colorectal Cancer Screening Program implemented a patient navigation (PN) intervention to increase colonoscopy screening among low-income patients in health centers in New Hampshire. In the current study, the authors examined the cost-effectiveness of this intervention. METHODS: A decision tree model was constructed using Markov state transitions to calculate the costs and effectiveness associated with PN. Costs were calculated for the implementation of PN in a statewide public health program and in endoscopy centers. The main study outcome was colonoscopy screening completion. The main decision variable was the incremental cost-effectiveness ratio associated with the PN intervention compared with usual care. RESULTS: The average cost per screening with PN was $1089 (95% confidence interval, $1075-$1103) compared with $894 with usual care (95% confidence interval, $886-$908). Among patients who were navigated, approximately 96.2% completed colonoscopy screening compared with 69.3% of those receiving usual care (odds ratio, 11.2; P <. 001). The incremental cost-effectiveness ratio indicated that 1 additional screening completion cost approximately $725 in a public health program and $548 in an endoscopy center with PN compared with usual care, both of which are less than the average Medicare reimbursement of $737 for a colonoscopy procedure. CONCLUSIONS: PN was found to be cost-effective in increasing colonoscopy screening among low-income adults in the New Hampshire Colorectal Cancer Screening Program, even at the threshold of current Medicare reimbursement rates for colonoscopy. The results of the current study support the implementation of PN in statewide public health programs and endoscopy centers.

Colorectal Cancer Screening: Preferences, Past Behavior, and Future Intentions.

BACKGROUND: Screening rates for colorectal cancer are below the Healthy People 2020 goal. There are several colorectal cancer screening tests that differ in terms of accuracy, recommended frequency, and administration. In this article, we compare how a set of personal characteristics correlates with preferences for colorectal cancer screening test attributes, past colorectal cancer screening behavior, and future colorectal cancer screening intentions. METHODS: We conducted a discrete-choice experiment survey to assess relative preferences for attributes of colorectal cancer screening tests among adults aged 50-75 years in USA. We used a latent class logit model to identify classes of preferences and calculated willingness to pay for changes in test attributes. A set of personal characteristics were included in the latent class analysis and analyses of self-reported past screening behavior and self-assessed likelihood of future colorectal cancer screening. RESULTS: Latent class analysis identified three types of respondents. Class 1 valued test accuracy, class 2 valued removing polyps and avoiding discomfort, and class 3 valued cost. Having had a prior colonoscopy and a higher income were predictors of the likelihood of future screening and membership in classes 1 and 2. Health insurance and a self-reported higher risk of developing colorectal cancer were associated with prior screening and higher future screening intentions, but not class membership. CONCLUSION: We identified distinct classes of preferences focusing on different test features and personal characteristics associated with reported behavior and intentions. Healthcare providers should engage in a careful assessment of patient preferences when recommending colorectal cancer test options to encourage colorectal cancer screening uptake.

Do cancer survivors change their prescription drug use for financial reasons? Findings from a nationally representative sample in the United States.

BACKGROUND: There is limited evidence from nationally representative samples about changes in prescription drug use for financial reasons among cancer survivors in the United States. METHODS: The 2011 to 2014 National Health Interview Survey was used to identify adults who reported ever having been told they had cancer (cancer survivors; n = 8931) and individuals without a cancer history (n = 126,287). Measures of changes in prescription drug use for financial reasons included: 1) skipping medication doses, 2) taking less medicine, 3) delaying filling a prescription, 4) asking a doctor for lower cost medication, 5) buying prescription drugs from another country, and 6) using alternative therapies. Multivariable logistic regression analyses were controlled for demographic characteristics, number of comorbid conditions, interactions between cancer history and number of comorbid conditions, and health insurance coverage. Main analyses were stratified by age (nonelderly, ages 18-64 years; elderly, ages ≥65 years) and time since diagnosis (recently diagnosed, <2 years; previously diagnosed, ≥2 years). RESULTS: Among nonelderly individuals, both recently diagnosed (31.6%) and previously diagnosed (27.9%) cancer survivors were more likely to report any change in prescription drug use for financial reasons than those without a cancer history (21.4%), with the excess percentage changes for individual measures ranging from 3.5% to 9.9% among previously diagnosed survivors and from 2.6% to 2.7% among recently diagnosed survivors (P < .01). Elderly cancer survivors and those without a cancer history had comparable rates of changes in prescription drug use for financial reasons. CONCLUSIONS: Nonelderly cancer survivors are particularly vulnerable to changes in prescription drug use for financial reasons, suggesting that targeted efforts are needed. Cancer 2017;123:1453-1463. © 2016 American Cancer Society.

Years of Life and Productivity Loss from Potentially Avoidable Colorectal Cancer Deaths in U.S. Counties with Lower Educational Attainment (2008-2012).

Background: Educational attainment (EA) is inversely associated with colorectal cancer risk. Colorectal cancer screening can save lives if precancerous polyps or early cancers are found and successfully treated. This study aims to estimate the potential productivity loss (PPL) and associated avoidable colorectal cancer-related deaths among screen-eligible adults residing in lower EA counties in the United States.Methods: Mortality and population data were used to examine colorectal cancer deaths (2008-2012) among adults aged 50 to 74 years in lower EA counties, and to estimate the expected number of deaths using the mortality experience from high EA counties. Excess deaths (observed-expected) were used to estimate potential years life lost, and the human capital method was used to estimate PPL in 2012 U.S. dollars.Results: County-level colorectal cancer death rates were inversely associated with county-level EA. Of the 100,857 colorectal cancer deaths in lower EA counties, we estimated that more than 21,000 (1 in 5) was potentially avoidable and resulted in nearly $2 billion annual productivity loss.Conclusions: County-level EA disparities contribute to a large number of potentially avoidable colorectal cancer-related deaths. Increased prevention and improved screening potentially could decrease deaths and help reduce the associated economic burden in lower EA communities. Increased screening could further reduce deaths in all EA groups.Impact: These results estimate the large economic impact of potentially avoidable colorectal cancer-related deaths in economically disadvantaged communities, as measured by lower EA. Cancer Epidemiol Biomarkers Prev; 26(5); 736-42. ©2016 AACR.

Health State Utility Impact of Breast Cancer in U.S. Women Aged 18-44 Years.

INTRODUCTION: Breast cancer affects women's health-related quality of life negatively, but little is known about how breast cancer affects this in younger women aged 18-44 years. This study measures preference-based health state utility (HSU) values, a scaled index of health-related quality of life for economic evaluation, for younger women with breast cancer and compares these values with same-age women with other cancers and older women (aged ≥45 years) with breast cancer. METHODS: Data from the 2009 and 2010 Behavioral Risk Factor Surveillance System were analyzed in 2014. The sample included 218,852 women; 7,433 and 18,577 had histories of breast and other cancers. HSU values were estimated using Healthy Days survey questions and a published mapping algorithm. Linear regression models for HSU were estimated by age group (18-44 and ≥45 years). RESULTS: The adjusted breast cancer HSU impact was four times larger for younger women than for older women (-0.097 vs -0.024, p<0.001). For younger women, the effect of breast cancer on HSU was 70% larger than that of other cancers (-0.097 vs -0.057, p=0.024). CONCLUSIONS: Younger breast cancer survivors reported lower HSU values than older survivors, highlighting the impact of breast cancer on the physical and mental health of younger women. The estimates may be used to evaluate quality-adjusted life-years or expectancy for prevention or treatment of breast cancer. This study also indicates that separate quality of life adjustments for women by age group are important for economic analysis of public health breast cancer interventions.

Medical Care Costs of Breast Cancer in Privately Insured Women Aged 18-44 Years.

INTRODUCTION: Breast cancer in women aged 18-44 years accounts for approximately 27,000 newly diagnosed cases and 3,000 deaths annually. When tumors are diagnosed, they are usually aggressive, resulting in expensive treatment costs. The purpose of this study is to estimate the prevalent medical costs attributable to breast cancer treatment among privately insured younger women. METHODS: Data from the 2006 MarketScan database representing claims for privately insured younger women were used. Costs for younger breast cancer patients were compared with a matched sample of younger women without breast cancer, overall and for an active treatment subsample. Analyses were conducted in 2013 with medical care costs expressed in 2012 U.S. dollars. RESULTS: Younger women with breast cancer incurred an estimated $19,435 (SE=$415) in additional direct medical care costs per person per year compared with younger women without breast cancer. Outpatient expenditures comprised 94% of the total estimated costs ($18,344 [SE=$396]). Inpatient costs were $43 (SE=$10) higher and prescription drug costs were $1,048 (SE=$64) higher for younger women with breast cancer than in younger women without breast cancer. For women in active treatment, the burden was more than twice as high ($52,542 [SE=$977]). CONCLUSIONS: These estimates suggest that breast cancer is a costly illness to treat among younger, privately insured women. This underscores the potential financial vulnerability of women in this age group and the importance of health insurance during this time in life.

Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors.

PURPOSE: To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. METHODS: We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one's share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). RESULTS: Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. CONCLUSION: Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.

Integrating Equity in a Public Health Funding Strategy.

OBJECTIVE: Equity can be valuable to guide decision makers about where to target funds; however, there are few studies for modeling vertical equity in public health program funding strategies. This case study modeled vertical equity in the funding strategy of the Centers for Disease Control and Prevention's Colorectal Cancer Control Program. DESIGN: To integrate vertical equity by using historical funding and health data, we (a) examined the need for colorectal cancer screening, (b) conducted multiple regressions to examine the relationship between factors of need and funding of states, (c) stratified states into similar need groups, (d) estimated vertical equity within groups, and (e) assessed equity in the funding distribution. RESULTS: Certain states with similar needs had high relative funding, whereas other states with similar needs had low relative funding. CONCLUSION: The methods used to integrate vertical equity in this case study could be applied in publicly funded programs to potentially minimize inequities and improve outcomes.

Annual Medical Expenditure and Productivity Loss Among Colorectal, Female Breast, and Prostate Cancer Survivors in the United States.

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.

Access to Cancer Care and General Medical Care Services Among Cancer Survivors in the United States: An Analysis of 2011 Medical Expenditure Panel Survey Data.

OBJECTIVES: Cancer survivors require appropriate health care to manage their unique health needs. This study describes access to cancer care among cancer survivors in the United States and compares access to general medical care between cancer survivors and people who have no history of cancer. METHODS: We assessed access to general medical care using the core 2011 Medical Expenditure Panel Survey (MEPS). We assessed access to cancer care using the MEPS Experiences With Cancer Survey. We used multivariable logistic regression to compare access to general medical care among 2 groups of cancer survivors (those who reported having access to all necessary cancer care [n = 1088] and those who did not [n = 70]) with self-reported access to general medical care among people who had no history of cancer (n = 22 434). RESULTS: Of the 1158 cancer survivors, 70 (6.0%) reported that they did not receive all necessary cancer care. Adjusted analyses found that cancer survivors who reported not receiving all necessary cancer care were also less likely to report receiving general medical care (78.0%) than cancer survivors who reported having access to necessary cancer care (87.1%) and people who had no history of cancer (87.8%). CONCLUSIONS: This study provides nationally representative data on the proportion of cancer survivors who have access to necessary cancer care and yields insight into factors that impede survivors' access to both cancer care and general medical care. This study is a reference for future work on access to care.

Enhancing screening and early detection among women transitioning to Medicare from the NBCCEDP in Georgia.

PURPOSE: The National Breast and Cervical Cancer Early Detection Program through each state's administration serves millions of low-income and uninsured women aged 40-64. Our purpose was to assess whether cases screened through Georgia's Breast and Cervical Cancer Program (BCCP) were diagnosed at an earlier stage of disease and whether those who used the state's program regularly continued to obtain age-appropriate screens as they aged out of BCCP into Medicare between 2000 and 2005. METHODS: We used BCCP screening data to identify women with more than one screen and an interval of 18 months or less between screens as "regular" users of BCCP. Using the linked BCCP and Medicare enrollment/claims data, we tested whether women with any BCCP use (n = 3,134) or "regular" users (n = 1,590) were more likely than women not using BCCP (n = 10,086) to exhibit regular screening under Medicare. We used linked BCCP and Georgia Cancer Registry data to examine breast cancer incidence and stage at diagnosis of BCCP women compared to the Georgia population. RESULTS: Under Medicare, almost 63 % of women with any BCCP use were re-screened versus 51 % of non-BCCP users. The probability of being screened within 18 months of Medicare enrollment was 3.5 % points higher for any BCCP user and 17.7 points higher for "regular" BCCP users, compared to nonusers. Among Black non-Hispanics, the difference for any BCCP user was 13.7 % points and for regular users, 22.4 % points. A larger percentage of BCCP users were diagnosed at in situ or localized disease stage than overall. CONCLUSIONS: The majority of women aging out of the GA BCCP 2000-2005 had used the program to obtain regular mammography. Regular users of GA BCCP continued to be screened within appropriate intervals once enrolled in Medicare due perhaps to educational and support components of BCCP.

Mental health services utilization and expenditures associated with cancer survivorship in the United States.

PURPOSE: The aim of this study is to assess mental health services utilization and expenditures associated with cancer history using a nationally representative sample in the US. METHODS: We used data from the 2008-2011 Medical Expenditure Panel Survey and multivariate regression models to assess mental health services use and expenditures among cancer survivors compared to individuals without a cancer history, stratified by age (18-64 and ≥65 years) and time since diagnosis (≤1 vs. >1 year). RESULTS: Among adults aged 18-64, compared with individuals without a cancer history, cancer survivors were more likely to screen positive for current psychological distress and depression regardless of time since diagnosis; survivors diagnosed >1 year ago were more likely to use mental health prescription drugs; those diagnosed within 1 year reported significantly lower annual per capita mental health drug expenditure and out-of-pocket mental health expenditure, while those diagnosed >1 year presented significantly higher annual per capita mental health expenditure. No significant differences in mental health expenditures were found among adults aged 65 or older. CONCLUSIONS: Mental health problems presented higher health and economic burden among younger and longer-term survivors than individuals without a cancer history. This study provides data for monitoring the impact of initiatives to enhance coverage and access for mental health services at the national level. IMPLICATIONS FOR CANCER SURVIVORS: Early detection and appropriate treatment of mental health problems may help improve quality of cancer survivorship.