S. Obeng-Gyasi1, L. Timsina1, O. Bhattacharyya3, S. E. Severance1, C. S. Fisher1, D. A. Haggstrom2 1Indiana University School Of Medicine,Department Of Surgery,Indianapolis, IN, USA 2VA HSR&D Center for Health Information and Communication,Indianapolis, IN, USA 3Indiana University Purdue University,Department Of Economics,Indianapolis, IN, USA
Introduction: Breast cancer is the most common female cancer in the United States. For working-age patients, a cancer diagnosis can be financially devastating secondary to disease related reduction in work productivity, loss of employment, and subsequent increased economic burden. The objective of this study is to understand out-of-pocket costs (OOP), health care utilization costs (outpatient visits, office-based visits, ambulatory care, prescription medication cost), and the rate of underinsurance among working age breast cancer patients.
Methods: The study data was obtained using the Medical Expenditure Panel Survey data from 2008-2012. Self-responding patients ages 18-64 with an age at diagnosis of breast cancer within two years of the survey interviews were included. The data was divided into three groups based on insurance: private, Medicaid, and other public. The other public includes patients with Non-Medicaid state or local insurance or other federal programs. Bivariate intergroup analysis was conducted. A multivariable logistic regression model tested variables associated with underinsurance. Underinsurance was defined as spending at least 10% of the household income on breast cancer related OOP.
Results:The study cohort included 14,586 patients. The groups differed significantly by marital status (p=0.004), race/ethnicity (p=0.0002), education (P <0.0001), percent below the poverty level (p<0.0001), family income (P <0.0001) and employment (P<0.0001). Mean total annual OOP costs were $2006.0 (95% CI 1705.5, 2305.5) for the privately insured, $991.0 (95% CI -160.1, 2142.3) for Medicaid, and $7420.0 (95% CI 1722.8, 13117) for other public insurance. The majority of OOP cost were on prescriptions, $706.0 (95% CI 557.7, 854.6), and office-based visits, $779. 0(95% CI 641.7, 916.3). Patients with other public insurance spent the most OOP costs on prescriptions $3258.0 (95% CI 2047.2, 4467.8) and office-based visits $3258.0 (95% CI 2047.2, 4467,8). Being divorced (OR 5.6, p=0.029), living in the Midwest (OR 18.6, p=0.001) or South (OR 7.49 p=0.015) compared to the Northwest and having other public insurance (OR 12.2, p=0.012) were all associated with an increased rate of underinsurance. Conversely, employment (OR 0.21, p=0.011) and having Medicaid (OR 0.09, p= 0.006) were associated with a reduced rate of underinsurance.
Conclusion:Breast cancer patients spend most of their OOP costs on prescriptions and office-based visits. Since Medicaid was protective against underinsurance and higher OOP costs, future longitudinal studies should monitor whether Medicaid policy changes continue to reduce the economic vulnerability among cancer patients. Fifteen states in the South and Midwest have not expanded Medicaid, and this public policy decision appears to expose breast cancer patients to substantially greater financial burdens. Medicaid expansion should be considered to mitigate financial burden among working age women with breast cancer.