Out-of-Pocket Costs Incurred by Patients with Cancer: Findings from a Retrospective Claims Analysis

Previous studies exploring the financial burdens of cancer care found that 42% of newly diagnosed patients with cancer were estimated to deplete life savings within 2 years. Diagnosing cancer earlier in the course of the disease may be associated with decreased morbidity, mortality, and costs stemming from treatment and management, potentially translating to decreased out-of-pocket costs for patients. In an aim to explore the economic burdens incurred by Medicare Advantage–insured patients following cancer diagnosis, annual and cumulative mean out-of-pocket costs by stage from years 1 through 3 post-diagnosis were estimated.

A retrospective analysis was conducted utilizing Optum’s de-identified Integrated Claims-Clinical dataset in conjunction with Enriched Oncology, which includes data from commercially insured patients and those insured by private payers offering Medicare Advantage coverage. Medicare Advantage–insured adults with staged breast, colorectal, lung, and prostate cancers diagnosed between January 1, 2016, and June 30, 2020, with enrollment for at least 1 month post-diagnosis were included. Mean out-of-pocket costs were calculated monthly over a 3-year period post-cancer diagnosis among those with continuous enrollment.

From 2016 to 2020, 5161 patients with newly diagnosed cancer were identified (breast: 39%; colorectal: 15%; lung: 33%; prostate: 14%). Annual and mean out-of-pocket costs generally increased by stage at diagnosis from years 1 through 3, with a few fluctuations by year or cancer type. However, results showed that out-of-pocket costs were significantly higher for patients with stage IV versus stage I cancer by the end of year 3 regardless of cancer type (mean cumulative year 3 out-of-pocket cost difference, stage I to IV, all cancers: P <.001). There were wide variations in cumulative mean out-of-pocket costs 3 years post-diagnosis, with a range of $8905 (stage I breast cancer) to $29,645 (stage IV lung cancer). By the end of year 3, the largest relative difference in cumulative mean out-of-pocket costs from stage I to IV was seen in colorectal cancer, with an increase of $13,181 (2.4 times). Colorectal cancer was followed by breast cancer, with an increase of $11,624 (2.3 times); lung cancer, with an increase of $13,283 (1.8 times); and prostate cancer, with an increase of $6636 (1.7 times).

These findings indicate significant economic burdens on Medicare Advantage–insured patients diagnosed with cancer. Additionally, late-stage (stage IV) cancer was associated with significantly higher mean cumulative out-of-pocket costs compared with early-stage (stage I) cancer in the 3-year period following diagnosis. These findings underscore the importance of continued focus on earlier detection of cancer not only for better prognosis, but also to reduce economic burdens experienced by patients.

Source:

McGarvey N, Gitlin M, Fadli E, et al. Out-of-pocket costs by cancer stage among Medicare Advantage-insured patients: 2016-2020. Presented at: 2022 Academy of Managed Care Pharmacy Nexus Annual Meeting; October 11-14, 2022; National Harbor, MD. Poster C34.