Cost of Care for the Initial Management of Cervical Cancer in Women with Commercial Insurance.

Abstract Background Women with newly diagnosed cervical cancer are often treated with extensive, multimodal therapy that may include a combination of surgery, radiation, and chemotherapy. Little is known about the cost of treatment or how costs are passed on to patients. Objective The objectives of the study were to examine the cost of care during the first year after the diagnosis of cervical cancer, to estimate the sources of cost and to explore the out-of-pocket costs. Study Design We performed a study of women with commercial insurance with newly diagnosed cervical cancer who were recorded in the MarketScan database from 2008-2016. Patients were classified based on primary treatment as either surgery (hysterectomy with or without adjuvant radiation or chemotherapy) or radiation. Medical expenditures for a 12-month period beginning on the date of first treatment, adjusted for inflation, were estimated. Payments were divided into expenditures of inpatient care, outpatient care (including chemotherapy), and outpatient pharmacy costs. Patient out-of-pocket costs in the form of copayments, coinsurance and deductibles were estimated. Results A total of 4495 patients, including 3014 (67%) who underwent surgery and 1481 (33%) who underwent primary radiotherapy, were identified. The median total expenditures per patient during the first year after diagnosis was $56,250 (interquartile range [IQR], $25,767–107,532). The median total expenditure for patients with primary surgical treatment was $37,222 (IQR, $20,957–75,555). The median total expenditure for patients treated with primary radiotherapy was $101,266 (IQR, $63,155–160,760). For patients treated primarily with surgery, inpatient services accounted for $15,145 (IQR, $0-26,898) in expenditures, outpatient services $18,430 (IQR, $5,354–48,047) and outpatient pharmacy costs $628 (IQR, $141–1,847). Median cost in those women who did not require adjuvant therapy was $26,164 compared to $89,760 in women treated with adjuvant radiation. The median out-of-pocket cost for the cohort was $2,253 (IQR $1,137–3,990) or 3.9% of total costs. Conclusion The cost of care for women with newly diagnosed cervical cancer is substantial. Overall, patients are responsible for approximately 3.9% of costs in the form of out-of-pocket expenditures.