The invited discussant of the study on out-of-pocket costs of cancer care, Michaela A. Dinan, PhD, Co-Leader of Cancer Prevention and Control at Yale Cancer Center and Associate Professor of Chronic Disease Epidemiology at the Yale School of Public Health, Connecticut, underscored the study’s key finding: out-of-pocket costs increased across all cancers, even for prostate and colorectal cancers, where total costs have remained unchanged. According to Dr. Dinan, this increase was driven largely by deductibles, which rose approximately 10% for all cancers during the study period.

“These results suggest that cost-containment by itself would not have prevented an increase in out-of-pocket costs, since out-of-pocket costs rose even when total costs were completely contained and were stable over time,” she observed.

According to Dr. Dinan, the substantially decreased costs seen with prostate radiation and colorectal systemic therapies, while other costs increased, is an important observation, especially since “lumping different cancers together without respect to disease site may have missed the phenomenon.” It’s possible, however, that without complete stage data some of these trends might be difficult to interpret, she said.

Michaela A. Dinan, PhD

‘Slightly Paradoxical’ Rate of Hospitalization

Dr. Dinan also highlighted the “slightly paradoxical” finding that the rate of hospitalization decreased over time while the cost of hospitalization rose substantially.

“It would be interesting to know how much hospitalizations increased for non–cancer care patients,” she said. “I want to see if the mean costs are explaining the full picture. For example, are all patients experiencing similar moderate bump in costs over time, or are these trends being driven by a few high-cost outliers?”

Future Steps

According to Dr. Dinan, one limitation of the study is the exclusive focus on costs from medical benefits, since only approximately half of patients in the cohort did not purchase pharmacy benefits.

“There may be a future opportunity to investigate the drug costs in patients who did have a pharmacy benefit, even if it’s a smaller cohort or a subset analysis,” Dr. Dinan concluded. “It would also be worth investigating whether the rising deductibles are being seen in publicly insured individuals and whether these data reflect a broader trend across cancers or even across other health conditions.” 

DISCLOSURE: Dr. Dinan has received research funding from AstraZeneca and Janssen.