Cancer Care Costs High Among Privately Insured Patients

TOPLINE:

A recent analysis found that privately insured US patients with newly diagnosed cancer, especially those with more advanced disease, had “substantial out-of-pocket costs.” Monthly out-of-pocket costs among these patients increased by a mean of almost $600, on average, but increased to nearly $720 per month for those with stage IV disease.

METHODOLOGY:

• Out-of-pocket costs for cancer care in the US are rising, but most research has focused on Medicare beneficiaries. It’s important to understand privately insured patients’ financial burdens, especially with cancer rates growing among younger Americans.
• Researchers conducted a retrospective study of 19,656 patients with cancer, using a dataset that links claims from a large private insurer to the Surveillance, Epidemiology, and End Results cancer registry.
• Overall, 74.1% had breast cancer, 14.5% had colorectal cancer, and 11.4% had lung cancer. Analyses also included 26,502 individuals without cancer who were assigned pseudo – diagnosis date.
• Monthly out-of-pocket costs (copays, co-insurance, and deductibles) were calculated from claims and inflation-adjusted to 2024 US dollars.

TAKEAWAY:

• After a cancer diagnosis, monthly out-of-pocket costs rose by $592, on average.
• Those added costs increased with disease stage, from $462 per month for stage 0 cancer to $720 per month for stage IV cancer.
• Out-of-pocket costs spiked in the month of diagnosis and remained elevated for 6 months compared with those in individuals without cancer — totaling an average of $4145 in cumulative additional costs (over 7 months).

IN PRACTICE:

“In this cohort study, patients with private insurance were found to have high OOPCs [out-of-pocket costs] after an incident diagnosis of cancer, and those with the most advanced cancer had the highest OOPCs,” the authors wrote. “The variability in OOPCs based on cancer stage underscores the need for policies such as paid sick leave, that address both insurance continuity and financial assistance, especially for patients with more advanced cancer.” 

SOURCE:

This study, led by Liam Rose, PhD, Stanford University School of Medicine, Palo Alto, California, was published online in JAMA Network Open.

LIMITATIONS:

Differential insurance attrition could have affected the results: Patients with stage IV cancer were most likely to drop their coverage. The study could only capture direct medical costs, which misses other potential financial burdens, such as lost income and travel expenses.

DISCLOSURES:

This study received funding support through a grant from the American Cancer Society. One author reported receiving grants from the Department of Veterans Affairs and National Institutes of Health during the conduct of the study. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.