Dissertations & Theses (Open Access)

Date of Award

Spring 5-2019

Degree Name

Doctor of Philosophy (PhD)


Robert O. Morgan, Phd

Second Advisor

Chan Shen, Phd

Third Advisor

Ruosha Li, Phd


The risk of depression is high for cancer patients and a large portion of cancer patients are age 65 and over. Both depression and cancer are economically burdensome and depression is associated with healthcare expenditure increase for elderly patients. However, whether comorbid depression affects healthcare expenditures in elderly cancer patients from payers’ and patients’ perspectives is largely unknown. Objective: To investigate whether depression is associated with higher healthcare expenditure among elderly cancer patients from both payers’ and patients’ perspectives and, and determine whether depression is associated with higher probability of having high out-of-cost burden. Methods: From the Medicare Current Beneficiary Survey (MCBS)-Medicare database, we identified breast, lung and prostate cancer patients aged 65 years or older who were newly diagnosed between 2007 and 2012 using Medicare claims. Presence of depression was based on self-reports from the surveys. Healthcare expenditures included expenditures incurred in the cancer diagnosis year and the subsequent calendar year. High out-of-cost burden was referred to as out-of-pocket cost as over 10% of respondent’s income. For the analyses of healthcare expenditures, generalized linear models (GLM) and two-part models were used to examine the impact of depression on healthcare expenditures when controlling for all other covariates assessed in the study. We stratified the analyses by healthcare service types and payers. For the analyses of high out-of-pocket cost burden, logistic regression was used to estimate whether depression was associated with higher probability of having high out-of-pocket cost burden. Results: Of the 710 elderly breast, lung and prostate cancer patients identified, 128 (18%) reported depression. The results revealed that elderly cancer patients with depression had $11,454 higher overall total healthcare expenditures. From Medicare’s perspective, elderly patients with depression incurred $8,280 higher expenditures, $4,327 higher medical provider expenditures and $870 higher expenditures on other services. They were also more likely to use inpatient services and other services. From the patients’ perspective, they had higher healthcare expenditures, medical provider expenditures and other expenditures ($1,270, $654 and $465, respectively). For high out-of-pocket cost burden, although the unadjusted result was significant, the adjusted result was not. Conclusions: Elderly patients with depression had significantly higher healthcare expenditures from the payers’ perspective. Although they did not have higher out-of-pocket cost burden, they did have higher healthcare expenditures from patients’ perspectives and over different expenditure types. These findings provide compelling evidence for policy makers, physicians and researchers to develop guidelines for and conduct studies of depression screening, diagnosis and treatment for geriatric cancer populations.