More cancer survivors using medical equipment, cost-sharing ‘far’ outweighs other services
Key takeaways:
- Medical equipment use among people with cancer increased 2.5-fold between 1999 and 2018.
- Equipment had the highest cost-sharing responsibility of any medical service.
Utilization of medical equipment among cancer survivors in the U.S. has more than doubled since the late 1990s, according to a research letter published in JAMA Network Open.
The cost-sharing responsibilities of medical equipment use has increased considerably during that period, as well.
Arjun Gupta, MD, assistant professor in the division of hematology, oncology and transplantation at University of Minnesota Medical School, and colleagues conducted a survey study to evaluate patterns of use and costs of medical equipment among U.S. cancer survivors.
Researchers used public data to identify adults with self-reported cancer who participated in the National Health Interview Survey (NHIS) between 1999 and 2018 or the Medical Expenditure Panel Survey (MEPS) between 2016 and 2020.
They identified 51,258 cancer survivors from NHIS, representing 17.9 million weighted individuals per year (57.1% women; 50.7% aged 65 years or older).
The weighted number of survivors who used medical equipment rose from 1.6 million in 1999 to 4 million in 2018. The adjusted prevalence of equipment utilization increased from 6.6% in 1999 to 8.6% in 2019 (P for trend < .001).
Researchers identified 12,436 cancer survivors from MEPS, representing 27.9 million weighted individuals per year (56.6% women; 55.9% aged 65 years or older).
They calculated mean yearly spending on medical equipment per survivor of $330 (standard deviation ± $11), of which $130 (standard deviation ± $6) was out-of-pocket, equaling a mean annual out-of-pocket responsibility of 39%.
“The first step in improving anything is recognizing and describing it. Financial toxicity as a term did not exist 10 or 15 years ago. Since then, it’s been named, shamed and intervened upon,” Gupta told Healio. “Even though clinicians knew that accessing and affording equipment is messy for patients, who may have to pay a significant portion out of pocket, these are the first data I’m aware of that objectively describe the issue.”
Healio spoke with Gupta about the motivation for this study, the implications of the findings and the next steps in research.
Healio: What motivated you to conduct this study?
Gupta: Much of our work over the past few years has focused on time toxicity or the time burdens in cancer care. We have been evaluating the time that patients and loved ones spend attending medical appointments, in waiting rooms, traveling etc. But when we asked patients and caregivers about other aspects of care that are time-consuming but do not add value, one issue that repeatedly came up involved the logistical and administrative challenges around fighting with insurance companies and paying bills, but also trying to access medical equipment. In clinical practice, we see an increasing number of cancer survivors, particularly older cancer survivors. As this group increases in number, we see increases in the sorts of functional limitations that might require the use of medical equipment such as wheelchairs, canes, and oxygen devices.
Healio: How did you conduct the study?
Gupta: We decided to look at two different databases, because we wanted to capture the nuance in these nationally representative surveys. The NHIS asks people if they have used equipment such as a cane, wheelchair or special bed. We used that to track the proportion of people using medical equipment. The MEPS collected costs that people were responsible for involving these services. By using these two databases, we could get an accurate idea of the actual rates of use and the associated costs.
Healio: What did you find in terms of equipment use?
Gupta: The prevalence of equipment use increased in absolute terms by 2% over the 20-year study period. This might not seem like a massive percentage but, because the absolute number of cancer survivors has increased so much over this time, it was a 2.5-fold increase in the number of people using equipment — from 1.6 million in 1999 to 4 million 2018.
Although this increase is impressive, the estimated 8.6 percentage prevalence of equipment use in the most recent study year — 2018 — is much lower than the reported rates of functional disability and mobility disability among cancer survivors. That number is more in the 25% to 70% range, depending on how you define it. Even though these numbers have increased, we can tell from these rates that most people are still unable to access equipment they need. One major limitation of this 8.6% number is that it doesn’t capture when patients need the equipment but are unable to access it.
Healio: What did you find in terms of medical equipment costs?
Gupta: We looked at cost-sharing responsibility, and we found that in the MEPS, medical equipment was the medical service associated with the highest cost-sharing responsibility. At 39%, it far outweighed other medical services. Insurers are not covering this medical equipment as much, and/or the administrative and logistical barriers are limiting patients’ access to equipment through proper channels, leading them to pay out of pocket through unofficial channels.
Healio: What are the potential implications of the findings?
Gupta: This is the first step toward much more work that needs to be done in this area. The ultimate goal is for patients to not have to spend hours on the phone fighting with insurance companies for things they need, and for them to not have to pay for all of this out of pocket.
Reference:
For more information:
Arjun Gupta, MD, can be reached at arjgupta@umn.edu.
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