Even With Insurance, Cancer Out-of-Pocket Costs Can Be Punishing

 Commercial health insurance does not necessarily protect cancer patients from potentially devastating out-of-pocket costs.

METHODOLOGY:

• Out-of-pocket costs contribute to financial toxicity in cancer, but little is known about how they vary across various tumor types and stages over time.
• To find out, investigators reviewed claims data for 7494 US patients diagnosed with stage I-IV breast, cervical, colorectal, lung, ovarian, or prostate cancer from 2016 to 2020.
• They assessed cumulative out-of-pocket (OOP) costs — defined as copayments, deductibles, and coinsurance — in the first 3 years following diagnosis.
• Subjects had private, commercial health insurance through United Healthcare.

TAKEAWAY:

• By the end of 3 years, average cumulative OOP costs ranged from $16,673 for stage I prostate cancer to $35,253 for stage IV lung cancer.
• Across all cancer types, average OOP costs in the first year ranged from $2,754 for stage I anal cancer to $25,876 for stage IV vaginal cancer.
• However, the upper limits of OOP costs exceeded $100,000 across many tumors and stages in the first year, reaching a high of $450,374 for stage I breast cancer and far exceeding $200,000 for stage II-IV colorectal and lung cancer.
• OOP costs were generally highest during the first year of treatment and for cancers diagnosed at later stages.

IN PRACTICE:

"OOP costs may present an extreme economic stressor on patients diagnosed with cancer," leading to emotional distress, reduced treatment adherence, and poor outcomes. "Even cancer patients with insurance coverage [are] not protected." Future research is "needed to help clarify the type of patient most burdened by OOP costs" as well as ways to reduce them, including promoting "diagnosis at an earlier stage and increas[ing] access to health plans that minimize patient cost sharing."

SOURCE:

The work was led by November McGarvey of BluePath Solutions, Los Angeles, and published in the Journal of Medical Economics.

LIMITATIONS:

The study did not include additional OOP costs, such as transportation. It also did not assess the long-term impacts of cancer-related out-of-pocket spending. Details on health plan types and features were limited, and the results are limited to patients with commercial health insurance.

DISCLOSURES:

The work was funded by Grail. The investigators are employees of Grail or BluePath Solutions.

https://www.medscape.com/s/viewarticle/even-insurance-cancer-out-pocket-costs-can-be-punishing-2023a1000udh