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Impact of high-deductible insurance on adjuvant hormonal therapy use in breast cancer.

Publication ,  Journal Article
Lu, CY; Zhang, F; Wagner, AK; Nekhlyudov, L; Earle, CC; Callahan, M; LeCates, R; Xu, X; Ross-Degnan, D; Wharam, JF
Published in: Breast Cancer Res Treat
August 2018

OBJECTIVE: High-deductible health plans (HDHPs) have become the predominant commercial health insurance arrangement in the US. HDHPs require substantial out-of-pocket (OOP) costs for most services but often exempt medications from high cost sharing. We examined effects of HDHPs on OOP costs and utilization of adjuvant hormonal therapy (AHT), which are fundamental care for patients with breast cancer. METHODS: This controlled quasi-experimental study used claims data (2003-2012) from a large national health insurer. We included 986 women with incident early-stage breast cancer, age 25-64 years, insured by employers that mandated a transition from low-deductible (≤ $500/year) to high-deductible (≥ $1000/year) coverage, and 3479 propensity score-matched controls whose employers offered only low-deductible plans. We examined AHT utilization and OOP costs per person-year before and after the HDHP switch. RESULTS: At baseline, the OOP costs for AHT were $40.41 and $36.55 per person-year among the HDHP and control groups. After the HDHP switch, the OOP costs for AHT were $91.76 and $72.98 per person-year among the HDHP and control groups, respectively. AHT OOP costs increased among HDHP members relative to controls but the change was not significant (relative change 13.72% [95% CI - 9.25, 36.70%]). AHT use among HDHP members did not change compared to controls (relative change of 2.73% [95% CI - 14.01, 19.48%]); the change in aromatase inhibitor use was - 11.94% (95% CI - 32.76, 8.88%) and the change in tamoxifen use was 20.65% (95% CI - 8.01, 49.32%). CONCLUSION: We did not detect significant changes in AHT use after the HDHP switch. Findings might be related to modest increases in overall AHT OOP costs, the availability of low-cost generic tamoxifen, and patient awareness that AHT can prolong life and health. Minimizing OOP cost increases for essential medications might represent a feasible approach for maintaining medication adherence among HDHP members with incident breast cancer.

Duke Scholars

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Published In

Breast Cancer Res Treat

DOI

EISSN

1573-7217

Publication Date

August 2018

Volume

171

Issue

1

Start / End Page

235 / 242

Location

Netherlands

Related Subject Headings

  • Public Health Surveillance
  • Patient Acceptance of Health Care
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Insurance, Health
  • Humans
  • Health Expenditures
  • Female
  • Deductibles and Coinsurance
 

Citation

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Lu, C. Y., Zhang, F., Wagner, A. K., Nekhlyudov, L., Earle, C. C., Callahan, M., … Wharam, J. F. (2018). Impact of high-deductible insurance on adjuvant hormonal therapy use in breast cancer. Breast Cancer Res Treat, 171(1), 235–242. https://doi.org/10.1007/s10549-018-4821-z
Lu, Christine Y., Fang Zhang, Anita K. Wagner, Larissa Nekhlyudov, Craig C. Earle, Matthew Callahan, Robert LeCates, Xin Xu, Dennis Ross-Degnan, and J Frank Wharam. “Impact of high-deductible insurance on adjuvant hormonal therapy use in breast cancer.Breast Cancer Res Treat 171, no. 1 (August 2018): 235–42. https://doi.org/10.1007/s10549-018-4821-z.
Lu CY, Zhang F, Wagner AK, Nekhlyudov L, Earle CC, Callahan M, et al. Impact of high-deductible insurance on adjuvant hormonal therapy use in breast cancer. Breast Cancer Res Treat. 2018 Aug;171(1):235–42.
Lu, Christine Y., et al. “Impact of high-deductible insurance on adjuvant hormonal therapy use in breast cancer.Breast Cancer Res Treat, vol. 171, no. 1, Aug. 2018, pp. 235–42. Pubmed, doi:10.1007/s10549-018-4821-z.
Lu CY, Zhang F, Wagner AK, Nekhlyudov L, Earle CC, Callahan M, LeCates R, Xu X, Ross-Degnan D, Wharam JF. Impact of high-deductible insurance on adjuvant hormonal therapy use in breast cancer. Breast Cancer Res Treat. 2018 Aug;171(1):235–242.
Journal cover image

Published In

Breast Cancer Res Treat

DOI

EISSN

1573-7217

Publication Date

August 2018

Volume

171

Issue

1

Start / End Page

235 / 242

Location

Netherlands

Related Subject Headings

  • Public Health Surveillance
  • Patient Acceptance of Health Care
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Insurance, Health
  • Humans
  • Health Expenditures
  • Female
  • Deductibles and Coinsurance