Negative impact of medical expenses high among patients with ASCVD, cancer
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Difficulty paying medical bills, financial stress, cost-related nonadherence and other financial toxicities were highly prevalent among patients with atherosclerotic CVD compared with those with cancer, researchers reported.
However, patients with both ASCVD and cancer reported the greatest levels of financial toxicity compared with those with either disease alone, according to research published in JACC: CardioOncology.
“To our knowledge, this is the first study directly analyzing financial toxicity in patients with cancer vs. patients with ASCVD. Prior studies have suggested that the effect of ASCVD on financial toxicity is likely equivalent to or greater than that of cancer, but this issue had not been definitively investigated,” Javier Valero-Elizondo, MD, MPH, of the division of cardiovascular prevention and wellness at Houston Methodist DeBakey Heart and Vascular Center, and colleagues wrote. “Our results not only confirm that individuals with a diagnosis of cancer have higher odds of all measures of financial toxicity than those without cancer nor ASCVD, but also highlight the burden that ASCVD represents in the overall adult population.”
For this analysis, researchers assessed data from the National Health Interview Survey and identified adults with self-reported ASCVD and/or cancer from 2013 to 2018 and were stratified as nonelderly or elderly.
Financial toxicity was defined as the presence of any one of the following: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity and/or forgone or delayed care due to cost.
Financial toxicity in ASCVD and cancer
Researchers observed that financial toxicity was more prevalent among individuals with ASCVD compared with cancer (54% vs. 41%; P < .001).
For the individual components of financial toxicity, patients with ASCVD had higher odds of the following compared with patients with cancer:
- any difficulty paying medical bills (OR = 1.22; 95% CI, 1.09-1.36);
- inability to pay bills (OR = 1.25; 95% CI, 1.04-1.5);
- cost-related medication nonadherence (OR = 1.28; 95% CI, 1.08-1.51);
- food insecurity (OR = 1.39; 95% CI, 1.17-1.64); and
- forgone/delayed care due to cost (OR = 1.17; 95% CI, 1.01-1.36).
According to the study, the presence of three or more of these factors was more prevalent among patients with ASCVD vs. cancer (23% vs. 13%; P < .001) and even greater among those with both ASCVD and cancer compared with cancer alone (30% vs. 13%; P < .001).
Moreover, findings were similar between the younger (age less than 65 years) and older populations.
“Our study highlights the degree to which patients with these diseases experience financial health-related consequences. Furthermore, we also broaden the scope of the financial toxicity phenomenon across all adults, nonelderly and elderly,” the researchers wrote.
The ‘incremental effect’ of financial toxicity
In a related editorial, Reza Arsanjani, MD, a cardiologist and echocardiographer, and Nandita Khera, MD, MPH, a hematologist and oncologist at Mayo Clinic Arizona, wrote about the significance of these findings and steps to improve costs for these patient populations moving forward.
“Although financial toxicity is not a novel concept, this study contributes to the field by comparing and describing the incremental effect on the various domains of financial toxicity when cancer and ASCVD coexist,” the editorial authors wrote. “Although the authors highlight some of the differences between these two diseases, such as the episodic high expenditures with chemotherapy vs. the chronic nature of most ASCVD, they have more in common than that which separates them. Comorbidities such as hypertension, hyperlipidemia, diabetes, arthritis and renal disease are commonly present in both disease entities leading to multimorbidity.
“Increasing price transparency, better integration of financial advocacy services and use of value-based insurance design to decrease cost-sharing burden is required at a system level to address this threat to access and quality of care,” Arsanjani and Khera wrote. “Finally, integrating financial stewardship and steps for early recognition and management of this problem in our academic curricula will ensure that the future generation of practitioners is more cognizant of this problem that can be devastating for our patients and their families.”
Reference:
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Eiman Jahangir, MD, MPH, FACC, FAHA
The cost of care is expensive among patients with cancer and those who require CV care, but significantly higher in those with combined cancer and CVD.
I am surprised. I would not expect the cost to be higher just because someone has ASCVD. Though I do understand that in patients with ASCVD there is a higher amount of medications, follow-ups and lifestyle changes expected.
A more proactive approach in prevention of CVD could be helpful. Maybe if patients visited with cardiologists prior to cancer treatment, they could get better control of their risk factors, on the right medications, etc. before undergoing chemotherapy.
This article speaks to the burden that health care costs have on our community/society. We need to continue working as a society to provide affordable care for everyone living in this country.
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