Privately insured, nonelderly patients face rising out-of-pocket costs for cancer care
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Increasing costs of cancer care and greater cost-sharing resulted in higher out-of-pocket costs for nonelderly, privately insured patients with breast, colorectal, lung and prostate cancers, according to study results.
The findings, published in Journal of the National Cancer Institute, suggest cost containment, as well as insurance reform, should be considered in policy initiatives to mitigate financial hardship.
Background
“Information on costs of cancer care mostly comes from SEER-Medicare data, which covers patients aged 65 years and older. Nonelderly patients with cancer and private insurance tend to receive more intensive treatment, and there is a trend of increasing numbers of high-deductible plans in the private insurance market,” Ya-Chen Tina Shih, PhD, professor of health services research at The University of Texas MD Anderson Cancer Center, told Healio. “These observations prompted us to study the trend in cancer treatments and costs — both total and out-of-pocket costs — around the first year of cancer diagnosis for nonelderly adults with private insurance.”
The study included patients with colorectal (n = 23,571), lung (n = 11,321), prostate (n = 59,197) and breast cancer (n = 105,255) diagnosed between 2009 and 2016.
Researchers used claims data from the Health Care Cost Institute to identify cancer-associated surgery, IV systemic therapy and radiation, and calculated associated total and out-of-pocket costs in 2020 U.S. dollars. They used logistic regression analyses and generalized linear models to assess trends in health care use and cost by cancer site.
Findings
Results showed significant increases in total mean costs per patient, from $109,544 in 2009 to $140,732 in 2016 (29%) for breast cancer, $151,751 to $168,730 (11%) for lung cancer and $53,300 to $55,497 (4%) for prostate cancer. However, the 1% increase in total mean costs per patient for colorectal cancer ($136,652 in 2009 to $137,663 in 2016) did not appear statistically significant.
Researchers found out-of-pocket costs increased to more than 15% for all cancer types, to more than $6,000 in 2016.
Moreover, results showed significant increases in use of IV systemic therapy and radiation for all cancers studied, except for lung cancer. Surgeries for breast and colorectal cancers also increased, whereas surgeries for prostate cancer decreased (P < .001).
“Providers might be able to prevent or mitigate financial hardship for their patients through financial hardship screening, patient-physician cost communication or connecting patients to financial navigation services,” Shih said.
Next steps
Researchers plan to compare costs of cancer care between elderly vs. nonelderly patients.
“We want to get a sense of how much more expensive cancer care is for nonelderly patients with private insurance compared with elderly patients with Medicare,” Shih said. “Over the years, the Centers for Medicare and Medicaid Services has tried to slow down the growth in Medicare expenditures, so we want to explore whether the difference in cancer care costs between these two age groups has widened over time, and what that means for patients’ financial burden.”
For more information:
Ya-Chen Tina Shih, PhD, can be reached at yashih@mdanderson.org.
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