and 3 other(s)
Uterine is the most common cancer of the female reproductive organs in the United States (US). An estimated 63,230 women will be diagnosed with uterine cancer this year, with 11,350 disease related deaths. The economic and humanistic burden of uterine cancer in the US has not been adequately assessed. This was a retrospective, cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) data from 2006-2015. Uterine cancer cases were identified using ICD-9 CM code 182 or clinical classification software code 25. Cases with a diagnosis of another cancer in addition to uterine cancer were excluded. The control group consisted of women without a diagnosis of cancer. Study outcomes included healthcare resource use, healthcare costs, activities of daily living, quality of life measures (SF-12v2 physical component score [PCS], mental component score [MCS], EQ-5D health utility, and PHQ-2 depression severity). Unadjusted bivariate analyses were conducted using t-tests for continuous variables and chi-square tests for categorical variables. Multivariate generalized linear models (GLMs) which controlled for key socio-demographic and clinical covariates were conducted for adjusted comparisons of study outcomes between uterine cancer cases and non-cancer controls. The final cohort consisted of 269,907 uterine cancer cases and 146,061,609 non-cancer controls. Uterine cancer cases were significantly older (mean age: 60.8 vs 37.0 years), had a higher BMI (mean BMI: 31.3 vs 26.5 kg/m2) and greater comorbidity burden (mean Charlson comorbidity index: 1.5 vs 0.5) compared to controls. Unadjusted bivariate analyses suggested that uterine cancer was associated with higher number of prescriptions (30.4 vs 11.0) and cost ($3,275 vs $975), inpatient visits (0.5 vs 0.1) and cost ($7,244 vs $1,225), institutional outpatient visits (12.7 vs 5.6) and cost ($2,855 vs $1,027), ER visits (0.4 vs 0.2), outpatient physician visits (1.8 vs 0.4) and cost ($1,651 vs $371), and total healthcare costs ($15,337 vs $3,829) (all P<0.05). A higher proportion of uterine cancer cases had physical (31.2% vs 10.2%), cognitive (7.8% vs 3.9%), social (13.4% vs 4.3%), and activity (22.4% vs 7.5%) limitations versus non-cancer controls (all P<0.05). Mean PCS score (41.5 vs 49.2) and EQ-5D utility (0.79 vs 0.86) was lower among uterine cancer cases versus non-cancer controls (all P<0.05). Results from the multivariate GLMs suggested that uterine cancer cases had a significantly higher number of inpatient visits (0.3 vs 0.1) and costs ($6,117 vs 1,446), outpatient physician visits (0.9 vs 0.5) and costs ($1,229 vs $502), institutional outpatient costs ($1,965 vs $1,322), total all-cause healthcare costs ($11,490 vs $4,909), and lower EQ-5D health utility (Beta coefficient = -0.273; P = 0.013) compared to non-cancer controls (all P<0.05). Uterine cancer is associated with significant healthcare resource use, cost burden, and health utility impairment.
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