Rising cost-sharing requirements from private insurance have exacerbated the financial burden for patients with cancer, according to research presented at the 2021 ASCO Quality Care Symposium.1
Analysis of claims data on the four most prevalent cancers in the United States—female breast, colorectal, lung, and prostate—has found a dramatic increase in out-of-pocket costs over time, even in cancers that are not increasing in total cost. The study of nearly 200,000 individuals diagnosed with cancer between 2009 and 2016 showed a rise in out-of-pocket costs of approximately 2% to 3% per year for all four cancers, even after adjustment for inflation, with deductibles accounting for a larger share of out-of-pocket costs, increasing from 30% to 40%, over the same time.
Over the 7-year duration of our study, the proportion of out-of-pocket costs coming from deductibles increased from 30% to 40%.— Ya-Chen Tina Shih, PhD
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“Our data showed that by 2016, patients with cancer were paying between $4,500 to $6,000 in this 14-month duration, and this happened even in the cancers with insignificant increase in total cost,” said lead study author Ya-Chen Tina Shih, PhD, Professor of Health Economics, Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston. “These findings suggest that policy actions to reduce the cost of cancer care alone may not be sufficient to ease the financial burden for those privately insured patients with cancer.”
As Dr. Shih reported, the national costs of cancer care are projected to increase by at least 34% over the next decade, reaching close to $250 billion based on population growth alone.2 However, the last comprehensive evaluation of trends in costs incurred in the first year of cancer diagnosis was published in 2008.3
What’s more, said Dr. Shih, there is limited information on the cost trends in nonelderly patients with cancer who have private insurance. These individuals tend to incur higher costs due to more aggressive care following initial diagnosis and have experienced higher out-of-pocket costs due to changes in insurance benefit plan design, most noticeably the increasing number of high-deductible plans.
Study Methods
For this study, Dr. Shih and colleagues evaluated total and out-of-pocket costs of cancer care around the first year of diagnosis (2 months before and 12 months after) among privately insured, nonelderly adults diagnosed with female breast, colorectal, lung, or prostate cancer. “These four cancers represent the four most prevalent cancers in the United States, and the 14-month duration captures the most expensive care phase in the cost trajectory of cancer,” Dr. Shih explained.
The researchers used claims data from the Health Care Cost Institute between 2009 and 2016 to identify treatment modality (cancer-related surgery, systemic therapy, radiation therapy, and other hospitalizations) and calculate associated total and out-of-pocket (sum of deductible, coinsurance, and copayment) costs from payment variables. For each cancer, Dr. Shih and colleagues examined health-care utilization and cost trends based on the year of diagnosis and conducted logistic regressions to assess the trend in utilization and generalized linear models to evaluate the trend in costs. All estimates are reported in 2020 U.S. dollars.
Deductibles Driving Out-of-Pocket Costs
As Dr. Shih reported, mean out-of-pocket costs trended upward at roughly 2% to 3% per year for all four cancers. Even in colorectal cancer, which did not increase in total cost during that time, said Dr. Shih, out-of-pocket costs still increased.
KEY POINTS
- Rising costs of cancer treatments, compounded with increasing cost-sharing, increased out-of-pocket costs for privately insured, nonelderly patients with female breast, colorectal, lung, and prostate cancers, according to a recent study.
- Policy initiatives to mitigate financial hardship should consider cost-containment as well as insurance reform.
“If you look at the composition of out-of-pocket costs, you can see the impact of deductibles,” Dr. Shih continued. “Over the 7-year duration of our study, the proportion of out-of-pocket costs coming from deductibles increased from 30% to 40%.”
Between 2009 and 2016, cancer surgeries significantly increased for breast and colorectal cancers but decreased for prostate cancer. Among those who underwent surgery, however, the cost increased for three (female breast, colorectal, and prostate) of the four cancers.
Over the same period, the utilization of systemic therapy increased for female breast, colorectal, and prostate cancers, and it remained relatively stable for lung cancer. The cost for systemic therapy trended up for all cancers except colorectal cancer, which decreased significantly due to the generic entry of oxaliplatin and irinotecan, according to Dr. Shih.
The use of radiation therapy also trended upward for breast and colorectal cancers, and downward for prostate cancer, and remained relatively stable for lung cancer. The cost of radiation therapy increased for all cancers except prostate.
“The reduction in the cost of radiation therapy likely reflects the effect of policies to reduce the reimbursement rate for intensity-modulated radiation therapy during this period, so this is an encouraging finding,” said Dr. Shih.
Hospitalizations for reasons other than cancer declined for all four cancers. Unfortunately, for those who were hospitalized, said Dr. Shih, the cost has continued to increase and is rather high.
Because this study period covered just patients diagnosed between 2009 and 2016, Dr. Shih acknowledged that the data fail to capture the economic impact of immunotherapy. A cohort of privately insured, younger patients also may not be generalized to elderly patients or those with public insurance, she added.
DISCLOSURE: Dr. Shih has received consulting fees, travel, and accommodations for serving on a grants review panel for Pfizer and an advisory board for AstraZeneca.
REFERENCES
1. Shih YC T, Xu Y, Bradley C, et al: Trends in total and out-of-pocket cost of cancer care around the first year of diagnosis for the four most common cancers among privately insured nonelderly adults: 2009–2016. 2021 ASCO Quality Care Symposium. Abstract 5. Presented September 25, 2021.
2. Mariotto AB, Enewold L, Zhao J, et al: Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiol Biomarkers Prev 29:1304-1312, 2020.
3. Warren JL, Yabroff KR, Meekins A, et al: Evaluation of trends in the cost of initial cancer treatment. J Natl Cancer Inst 100:888-897, 2008.
