High-Deductible Health Plans and Out-of-Pocket Health Care Costs Among Younger Patients With Multiple Myeloma

This study aimed to determine if high-deductible health plan (HDHP) enrollment contributes to financial burden and hinders access to care for patients with multiple myeloma (MM).

Patients diagnosed with MM from 2010 to 2020 were identified in Merative MarketScan, an employer-based health insurance database. Primary outcomes were total health care and out-of-pocket (OOP) costs in the year after diagnosis. Secondary outcomes included time to treatment initiation and stem-cell transplant receipt. Multivariable analyses using linear, logistic, and Cox regression were performed, as appropriate. Covariates included age, sex, year diagnosed, comorbidities, data provider, and stem-cell transplant receipt.

The cohort included 4,029 patients; 17.6% were enrolled on HDHPs. HDHP enrollees were younger (mean age, 54.9 v 55.5 years; P = .036). Over the first year, mean total and OOP costs were $406,401 in US dollars (USD) and $9,220 USD for HDHP enrollees, respectively, versus $386,802 USD (P = .027) and $7,021 USD (P < .001) for the standard plan enrollees. There was no statistically significant difference in total cost (β = 11; P = .999) but mean OOP costs were $2,544 USD (β = 2,544; P < .001) higher for HDHP enrollees after adjusting for covariates. The additional OOP costs incurred in the first 2 months, presumably because of deductibles, and after the deductible reset. Contrary to our hypothesis, HDHPs enrollees had shorter time to treatment initiation (median, 20 v 22 days; hazard ratio, 1.18; P < .001) and were more likely to receive a stem-cell transplant (55.1% v 47.6%; odds ratio, 1.25; P = .010), after adjusting for covariates.

Compared with standard plan enrollees, OOP costs were higher for HDHP enrollees in the year after diagnosis, but HDHP enrollment was not associated with delays in treatment initiation or reduced access to stem-cell transplant.