A diagnosis of cancer brings substantially higher out-of-pocket costs (OOPCs) for privately insured patients, particularly those with more advanced cancer, researchers found.
In a cohort of more than 46,000 patients, an incident cancer diagnosis was associated with a mean increase in OOPCs of $592.53 per month in the 6 months after diagnosis, reported Liam Rose, PhD, of the Stanford University School of Medicine in Palo Alto, California, and colleagues.
This finding “underscores the financial burden of cancer care on patients with insurance who are not yet eligible for Medicare,” wrote Rose and colleagues in JAMA Network Open. “Our findings provide quantitative evidence that even with private insurance, OOPCs were higher in the month of diagnosis and in the months after diagnoses compared with costs for a control group.”
Among patients grouped by stage at diagnosis, the authors found no significant difference in monthly OOPCs before diagnosis. However, for the 6 months after diagnosis, the mean OOPC increase ranged from $462.01 per month for patients with stage 0 cancers to $719.97 per month for patients with stage IV cancers.
Differences in OOPCs between individuals with or without cancer were much greater in the month of diagnosis and decreased in the months after.
For example, the OOPC difference between cancer patients with stage 0 disease and non-cancer patients was $1,360.80 at diagnosis, $229.26 at 3 months after diagnosis, and $10.10 at 6 months. The OOPC difference between cancer patients with stage IV disease and individuals without cancer was $2,276.37 at diagnosis, $338.34 at 3 months, and $299.61 at 6 months.
“This result seems straightforward,” Rose and colleagues wrote. “Later-stage disease is associated with more intensive workup and treatment that can drive higher medical expenditures. However, this result has not previously been empirically demonstrated, to our knowledge.”
This cohort study used Optum administrative claims data of a large insurer linked to the Surveillance, Epidemiology, and End Results cancer registry. The study included individuals living in the U.S. from 2008 to 2022 who were under age 65 years, insured through a large national private health insurer, and had 6 or more months of continuous enrollment.
Patients were excluded if they were enrolled in a Medicare Advantage plan at any time during their enrollment in Optum, had no associated medical claims, or were missing cancer stage.
The 46,158-patient study population was two-thirds female, over two-thirds white, 8.9% Black, 7.8% Hispanic, and 5.5% Asian. The cohort included 19,656 patients with cancer (42.6%) and 26,502 patients without cancer (57.4%) as a control group.
About three-fourths of the patients with cancer had breast cancer, while 14.5% had colorectal cancer and 11.4% lung cancer. The mean age at diagnosis was 46 years.
The authors acknowledged the study had several limitations, including that individuals with cancer may be more likely to drop insurance coverage due to mortality, loss of employment, or a desire to change insurance coverage.
Thus, “differential attrition may have biased our estimates upward if a significant portion of the cancer group dropped their insurance coverage shortly after receiving an incident diagnosis,” Rose and colleagues observed.
Rose reported receiving grants from the Department of Veterans Affairs and National Institutes of Health during the conduct of the study.
