Financial toxicity for cancer patients: Out-of-pocket costs by cancer diagnosis in traditional Medicare.

Abstract

11092 Background: Financial toxicity is defined as the fiscal issues that can arise in a patient’s life related to the costs of medical care (DOI: 10.1093/tbm/ibab091). These can include financial distress, resource rationing and even medical debt. A patient’s spending obligation is measured through out-of-pocket costs (OOP) which are comprised of copayments, co-insurance and/or deductibles (DOI: 10.18553/jmcp.2022.21270). Cancer patients face especially high costs and potentially greater risk of financial distress compared to other illnesses (DOI: 10.1093/tbm/ibab091). An American Cancer Society survey of 1,218 cancer patients/survivors found that over half (51%) of respondents reported medical debt resulting from cancer treatment despite nearly all (98%) having active insurance (https://www.fightcancer.org/policy-resources/costs-cancer-survivorship-2022). Our study aims to qualify and quantify the cancers with the highest out-of-pocket costs for beneficiaries in Traditional, or Fee-for-service, Medicare (TM) to determine cancers that expose patients to the highest financial risk. Methods: A 5% sample of TM beneficiaries in 2023 was collected, which included 1.3 million individuals and 261,099 unique beneficiaries with some form of cancer. Beneficiary claims were categorized by International Classification of Disease (ICD-10) coded cancer diagnoses. Patient OOP costs were aggregated across inpatient, outpatient and prescription drug settings using Medicare Beneficiary Summary File (MBSF) and Prescription Drug Event (PDE) claims data across Parts A, B and D Medicare, respectively. Costs per beneficiary were sorted by highest average out-of-pocket cost per beneficiary organized by cancer diagnosis. Comparison groups in our sample included a cohort of TM beneficiaries with any type of cancer and beneficiaries without cancer. Results: The 5 cancers with the highest average out-of-pocket costs annually in 2023 were multiple myeloma ($14,400), acute leukemia ($10,498), biliary cancers ($9,725), hepatocellular carcinoma ($9,469) and pulmonary (small and non-small-cell) cancers ($8,572). This is relative to TM beneficiaries with any cancer who spent an average of $4,800 annually OOP in 2023 and $2,364 for beneficiaries without cancer in TM. Prescription drugs are a substantial component of OOP cost for certain cancers. For multiple myeloma and acute leukemia, 19.8% and 21.5% of OOP costs were attributable to prescriptions compared to 8.6%, 8.1% and 10.2% for biliary, hepatocellular and lung cancer, respectively. Conclusions: Cancer is expensive for Medicare patients in the United States. These OOP costs can pose severe affordability issues for TM beneficiaries, who had an average income of $36,000 annually in 2023 (https://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-in-2023/). Within TM, patients with multiple myeloma, acute leukemia, biliary, hepatocellular and lung cancers experience especially high costs and have an elevated risk of financial toxicity. Multiple myeloma and acute leukemia notably have significantly higher prescription cost-sharing through Part D compared to high-cost solid tumors.