Out-of-pocket costs among women with breast cancer: data from the medical expenditure panel survey, 1996-2005.

CTRC-AACR San Antonio Breast Cancer Symposium: 2008 Abstracts Abstract #3111 BACKGROUND: The Food and Drug Administration's (FDA) approval of new therapies in cancer has increased the number of treatment options to patients but has also increased the cost of care. In an effort to manage costs, patients are increasingly asked to pay more out of pocket (OOP), which may result in patients having to make financial trade-offs and potentially not receiving the best therapies because of financial barriers. Data on socioeconomic characteristics and OOP costs among women with breast cancer are limited. This study provides detailed data on the OOP costs of a nationally representative sample of breast cancer patients from a large-scale survey in the US. METHODS: This retrospective database study included all female respondents in the Medical Expenditure Panel Survey (MEPS) between 1996 and 2005 who had a breast cancer diagnosis (ICD-9-CM 174) recorded on a pharmacy, inpatient, outpatient, office, home health, or ER claim. All 10 years were pooled and weighted to create nationally representative estimates. Descriptive analyses of demographics, socioeconomics, and insurance status were performed (patients were deemed uninsured if they reported no insurance at any point during the year), and total annual medical expenditures, OOP expenditures (not including premiums), and family income (in 2007 US $) were analyzed. Patients were defined as having a high OOP burden if their OOP expenditures exceeded 10% of annual family income (or 5% if low income). RESULTS: We identified 728 women for inclusion in this study, representing 798,342 individuals in the US (mean age: 61 yrs; 86% white and 6% African American; 25% low income [<200% of federal poverty level] and 30% middle income [200-399% of poverty level]; 41% privately insured, 22% with public insurance, 29% with both, 6% uninsured, and 2% with unknown insurance). Total annual medical expenditures were $14,924, including $2,219 spent OOP. Mean annual family income was $70,221, and 22% of all patients had a high OOP burden. The percent with high burden was highest among the uninsured (33%), those with both public and private insurance (32%), and those with public insurance only (30%). Of those with unknown insurance, 20% had a high burden, and 9% of the privately insured had a high OOP burden. Older patients were more likely to have a high burden: 39% of the 75+ age group and 26% of patients aged 65-74 vs. 18% of those aged 55-64 and 10% each for the 45-54 and <45 age groups. CONCLUSIONS: This study appears to be the first to report recent OOP expenditures for a nationally representative sample of breast cancer patients of all ages. We found that 22% of all breast cancer patients had a high OOP burden, with the proportion being higher among older women, the uninsured, and those with public insurance. With more than 1 in 5 breast cancer patients having a high OOP burden, it is important for payers, providers, manufacturers, and policymakers to explore ways to reduce the OOP burden so patients can access appropriate therapies. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3111.