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Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment.

Publication ,  Journal Article
Wharam, JF; Zhang, F; Lu, CY; Wagner, AK; Nekhlyudov, L; Earle, CC; Soumerai, SB; Ross-Degnan, D
Published in: J Clin Oncol
April 10, 2018

Purpose High-deductible health plans (HDHPs) require substantial out-of-pocket spending and might delay crucial health services. Breast cancer treatment delays of as little as 2 months are associated with adverse outcomes. Methods We used a controlled prepost design with survival analysis to assess timing of breast cancer care events among 273,499 women age 25 to 64 years without evidence of breast cancer before inclusion. Women were included if continuously enrolled for 1 year in a low-deductible ($0 to $500) plan followed by up to 4 years in a HDHP (at least $1,000 deductible) after an employer-mandated switch. Study inclusion was on a rolling basis, and members were followed between 2003 and 2012. The comparison group comprised 2.4 million contemporaneously matched women whose employers offered only low-deductible plans. Measures were times to first diagnostic breast imaging (diagnostic mammogram, breast ultrasound, or breast magnetic resonance imaging), breast biopsy, incident early-stage breast cancer diagnosis, and breast cancer chemotherapy. Outcomes were analyzed by using Cox models and adjusted for age-group, morbidity score, poverty level, US region, index date, and employer size. Results After the index date, HDHP members experienced delays in receipt of diagnostic imaging (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.94 to 0.96), biopsy (aHR, 0.92; 95% CI, 0.89 to 0.95), early-stage breast cancer diagnosis (aHR, 0.83; 0.78 to 0.90), and chemotherapy initiation (aHR, 0.79; 95% CI, 0.72 to 0.86) compared with the control group. Conclusion Women switched to HDHPs experienced delays in diagnostic breast imaging, breast biopsy, early-stage breast cancer diagnosis, and chemotherapy initiation. Additional research should determine whether such delays cause adverse health outcomes, and policymakers should consider selectively reducing out-of-pocket costs for key breast cancer services.

Duke Scholars

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

April 10, 2018

Volume

36

Issue

11

Start / End Page

1121 / 1127

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Risk Factors
  • Predictive Value of Tests
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Mammography
  • Insurance, Health
 

Citation

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MLA
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Wharam, J. F., Zhang, F., Lu, C. Y., Wagner, A. K., Nekhlyudov, L., Earle, C. C., … Ross-Degnan, D. (2018). Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment. J Clin Oncol, 36(11), 1121–1127. https://doi.org/10.1200/JCO.2017.75.2501
Wharam, J Frank, Fang Zhang, Christine Y. Lu, Anita K. Wagner, Larissa Nekhlyudov, Craig C. Earle, Stephen B. Soumerai, and Dennis Ross-Degnan. “Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment.J Clin Oncol 36, no. 11 (April 10, 2018): 1121–27. https://doi.org/10.1200/JCO.2017.75.2501.
Wharam JF, Zhang F, Lu CY, Wagner AK, Nekhlyudov L, Earle CC, et al. Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment. J Clin Oncol. 2018 Apr 10;36(11):1121–7.
Wharam, J. Frank, et al. “Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment.J Clin Oncol, vol. 36, no. 11, Apr. 2018, pp. 1121–27. Pubmed, doi:10.1200/JCO.2017.75.2501.
Wharam JF, Zhang F, Lu CY, Wagner AK, Nekhlyudov L, Earle CC, Soumerai SB, Ross-Degnan D. Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment. J Clin Oncol. 2018 Apr 10;36(11):1121–1127.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

April 10, 2018

Volume

36

Issue

11

Start / End Page

1121 / 1127

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Risk Factors
  • Predictive Value of Tests
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Mammography
  • Insurance, Health