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Total and out-of-pocket expenditures among women with metastatic breast cancer in low-deductible versus high-deductible health plans.

Publication ,  Journal Article
Leopold, C; Wagner, AK; Zhang, F; Lu, CY; Earle, CC; Nekhlyudov, L; Ross-Degnan, D; Wharam, JF
Published in: Breast Cancer Res Treat
September 2018

PURPOSE: High-deductible health plan (HDHP) enrollment is expanding rapidly and might substantially increase out-of-pocket (OOP) payment burden. We examined trends in total and OOP health service expenditures overall and by insurance coverage type among women with metastatic breast cancer. METHODS: We used a longitudinal time series design to examine measures among 5364 women with metastatic breast cancer insured by a large US health insurer from 2004 to 2011. We measured outcomes during the 12 months after a first identified metastatic breast cancer diagnosis and required women to have at least 6 months of prior enrollment. We plotted enrollment measures and adjusted total and OOP spending. We fit trend lines using linear autoregressive models. RESULTS: Between 2004 and 2011, the percentage of women with metastatic breast cancer enrolled in employer-mandated HDHPs increased from 8 to 23% while the percentage enrolled in employer-mandated low-deductible plans (LDHPs) decreased from 69 to 37%. Over the same time period, estimated annual inflation-adjusted total health service spending among women with metastatic breast cancer whose employers only offered HDHPs or LDHPS increased from $96,899 to $104,688 (increase of $1197 per year; 95% confidence interval [CI]: $47,$2,348). Corresponding OOP spending values among these women with employer-mandated deductible levels were $4,496 and $5,151 ($91 per year trend; 95% CI -$13,$195). From 2004-2011, women in HDHPs and LDHPs had unchanged annual OOP spending, estimated at of $6642 (95% CI $6,268,$7016) and $4,247 (95% CI $3956,$4538), respectively. Thus, women in HDHPs experienced 55% (44%, 66%) more OOP spending than women in LDHP. CONCLUSIONS: OOP spending among women with metastatic breast cancer and employer-mandated deductible levels was 55% higher among HDHP than LDHP members, and employer-mandated HDHP enrollment increased substantially from 2004 to 2011. Stakeholders and policymakers should design health plans that protect financially vulnerable cancer patients from high OOP costs.

Duke Scholars

Published In

Breast Cancer Res Treat

DOI

EISSN

1573-7217

Publication Date

September 2018

Volume

171

Issue

2

Start / End Page

449 / 459

Location

Netherlands

Related Subject Headings

  • Public Health Surveillance
  • Oncology & Carcinogenesis
  • Middle Aged
  • Insurance, Health
  • Insurance Coverage
  • Humans
  • Health Expenditures
  • Female
  • Deductibles and Coinsurance
  • Costs and Cost Analysis
 

Citation

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Leopold, C., Wagner, A. K., Zhang, F., Lu, C. Y., Earle, C. C., Nekhlyudov, L., … Wharam, J. F. (2018). Total and out-of-pocket expenditures among women with metastatic breast cancer in low-deductible versus high-deductible health plans. Breast Cancer Res Treat, 171(2), 449–459. https://doi.org/10.1007/s10549-018-4819-6
Leopold, Christine, Anita K. Wagner, Fang Zhang, Christine Y. Lu, Craig C. Earle, Larissa Nekhlyudov, Dennis Ross-Degnan, and J Frank Wharam. “Total and out-of-pocket expenditures among women with metastatic breast cancer in low-deductible versus high-deductible health plans.Breast Cancer Res Treat 171, no. 2 (September 2018): 449–59. https://doi.org/10.1007/s10549-018-4819-6.
Leopold C, Wagner AK, Zhang F, Lu CY, Earle CC, Nekhlyudov L, et al. Total and out-of-pocket expenditures among women with metastatic breast cancer in low-deductible versus high-deductible health plans. Breast Cancer Res Treat. 2018 Sep;171(2):449–59.
Leopold, Christine, et al. “Total and out-of-pocket expenditures among women with metastatic breast cancer in low-deductible versus high-deductible health plans.Breast Cancer Res Treat, vol. 171, no. 2, Sept. 2018, pp. 449–59. Pubmed, doi:10.1007/s10549-018-4819-6.
Leopold C, Wagner AK, Zhang F, Lu CY, Earle CC, Nekhlyudov L, Ross-Degnan D, Wharam JF. Total and out-of-pocket expenditures among women with metastatic breast cancer in low-deductible versus high-deductible health plans. Breast Cancer Res Treat. 2018 Sep;171(2):449–459.
Journal cover image

Published In

Breast Cancer Res Treat

DOI

EISSN

1573-7217

Publication Date

September 2018

Volume

171

Issue

2

Start / End Page

449 / 459

Location

Netherlands

Related Subject Headings

  • Public Health Surveillance
  • Oncology & Carcinogenesis
  • Middle Aged
  • Insurance, Health
  • Insurance Coverage
  • Humans
  • Health Expenditures
  • Female
  • Deductibles and Coinsurance
  • Costs and Cost Analysis