Estimated Out-of-Pocket Costs for Patients With Common Cancers and Private Insurance

Area of Science:

• Health Economics
• Oncology
• Health Services Research

Background:

• Cancer diagnosis imposes a significant financial burden on patients, often exacerbated by advanced disease and intensive treatment requirements.
• Understanding the out-of-pocket costs (OOPCs) associated with initial cancer treatment is crucial for assessing patient financial toxicity.

Purpose of the Study:

• To investigate the out-of-pocket costs (OOPCs) associated with the initial treatment of common cancers (breast, colorectal, lung) among privately insured individuals.
• To compare OOPCs across different cancer stages and with individuals without a cancer diagnosis.

Main Methods:

• Retrospective cohort study utilizing administrative claims data from a large US private health insurer linked to SEER cancer registry data.
• Employed difference-in-differences methods to compare OOPCs between cancer patients and a matched control group without cancer.
• Included privately insured individuals aged <65 years in the US (2008-2022) with continuous enrollment.

Main Results:

• An incident cancer diagnosis was associated with a mean monthly OOPC increase of $592.53 in the 6 months post-diagnosis.
• OOPCs demonstrated a monotonic increase with disease stage, ranging from $462.01/month for stage 0 to $719.97/month for stage 4.
• The study included 46,158 patients (19,656 with cancer), with breast, colorectal, and lung cancers being the most common.

Conclusions:

• Privately insured patients incur substantial OOPCs following a cancer diagnosis, with advanced-stage cancer patients facing the highest costs.
• Further research is warranted to explore the clinical and financial implications of these elevated OOPCs for cancer patients.