2018 ASCO Annual Meeting!
Session: Breast Cancer—Local/Regional/Adjuvant
Type: Poster Session
Time: Saturday June 2, 8:00 AM to 11:30 AM
Location: Hall A
Impact of high deductible insurance on out-of-pocket cost burden in breast cancer.
2018 ASCO Annual Meeting
Poster Board Number:
Poster Session (Board #37)
J Clin Oncol 36, 2018 (suppl; abstr 545)
Author(s): Christine Lu, Fang Zhang, Anita K. Wagner, Larissa Nekhlyudov, Craig Earle, Matthew Callahan, Robert LeCates, Xin Xu, Jamie Wallace, Stephen Soumerai, Dennis Ross-Degnan, James Frank Wharam; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Ontario Institute for Cancer Research, Toronto, ON, Canada
Background: High-deductible health plans (HDHP) requiring out-of-pocket (OOP) costs for most services may place heavy economic burden on patients. This study examined the impact of modern HDHPs on OOP costs among women with early-stage breast cancer. Methods: We included 886 women with incident early-stage breast cancer, age 25 to 64 years, who were insured by employers that mandated a transition from low-deductible ( < = $500/year) to high deductible ( > = $1000/year) coverage, and 3099 exact matched contemporaneous patients whose employers offered only low-deductible plans. Measures were pharmacy and medical OOP costs per person-year. Medical services were categorized as inpatient, emergency room (ER), primary care visits, and outpatient care which included specialist visits, radiology, lab tests, and chemotherapy. We calculated OOP costs as the sum of deductibles, copays, and coinsurance. Effect estimates of changes between study groups were established using difference-in-differences analyses. Results: HDHP members faced an absolute baseline-to-follow-up increase in total OOP costs of $1067 per person-year compared to controls (p = < 0.001). The absolute change in medical OOP costs per person-year among HDHP members compared to controls from baseline to follow-up was significant ($1004, 95% CI: [$580, $1429]) and the relative change was also significant (41.2%, 95% CI: [17.8%, 64.5%]). The increase in medical OOP costs was driven by increases in outpatient care OOP costs. The absolute change in outpatient care OOP costs per person-year among HDHP members compared to controls from baseline to follow-up was $919 (95% CI: [$506, $1332]; relative change: 43.7%, 95% CI: [17.0%, 70.5%]). Changes in OOP costs for pharmacy, inpatient, ER, and primary care visits were not significant. Conclusions: In this rigorous, natural experimental study, women with incident breast cancer experienced increases in total OOP costs after employer-mandated HDHP switches, a change driven by a 44% increase in outpatient care OOP costs. Further research should examine which outpatient services contributed to this substantial economic burden, when the differences occur and the proportion of women reaching their annual deductible.
1. TAILORx: Phase III trial of chemoendocrine therapy versus endocrine therapy alone in hormone receptor-positive, HER2-negative, node-negative breast cancer and an intermediate prognosis 21-gene recurrence score.