High-deductible health plans linked to delays in metastatic cancer detection
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CHICAGO — Patients with high-deductible health plans experienced delays in detection of metastatic cancer, according to results of an observational study presented during ASCO Annual Meeting.
“High-deductible health plans have grown rapidly during the last decade, and more than half of American workers are now covered by health plans with deductibles greater than $1,000,” Nicolas Karim Trad, BA, medical student at Harvard Medical School, told Healio. “The growing dominance of [these plans] makes it important to study their impact on the quality and timeliness of cancer care.”
Rationale and methods
Trad and colleagues examined the impact of high-deductible health plans on the timing of metastatic cancer detection among 345,401 individuals (mean age, 42 years; 49% female) with high-deductible health plans compared with 1,654,775 individuals (mean age, 42 years; 50% female) with low-deductible plans. Of note, both groups had a 1-year baseline period when all members were enrolled in low-deductible plans.
Researchers matched study participants according to age, sex, race/ethnicity and morbidity (ACG) score, as well as poverty level, geographic region, employer size, baseline primary cancer, baseline medical and pharmacy costs and duration of follow-up. Both the high-deductible and low-deductible cohorts had a mean ACG score of 1.4.
Researchers used a validated claims-based algorithm to detect incident metastatic cancer diagnoses and assessed time to diagnosis during baseline and follow-up using weighted Cox proportional hazards model.
Follow-up was a maximum of 13.5 years.
Key findings
Researchers observed no differences in time to metastatic diagnosis at baseline (HR = 0.96). However, individuals with high-deductible health plans experienced longer time to first metastatic cancer diagnosis (HR = 0.88; P = .01), which indicated delayed cancer detection compared with the control group.
Looking ahead
Future research should explore the potential impact of these delays, which may lead to increased disease burden at treatment initiation and worse clinical outcomes, Trad said.
“We are now looking to understand these patterns with more granularity,” Trad said. “For instance, we are working to distinguish the impacts of high-deductible health plans on de novo metastatic diagnoses vs. metastatic recurrences in patients with previously diagnosed cancers. These are groups that may differ regarding financial reserves, priorities regarding metastatic diagnosis and understanding of insurance systems.”
For more information:
Nicolas Karim Trad, BA, can be reached at nicolas_trad@hms.harvard.edu.
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Trad NK, et al. Abstract 6503. Presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
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