Peppercorn Jeffrey, Hasler Jill S, Hu Bonnie, Tagai Erin K, Zahner Greg J, Lam Anh, Robbins Sarina, Wheeler Stephanie B, Nipp Ryan D, Miller Suzanne M
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA.
Cancer. 2025 Jan 15;131(2):e35721. doi: 10.1002/cncr.35721.
Little is known about the role that charitable copay assistance (CPA) plays in addressing access to care and financial distress. The study sought to evaluate financial distress and experience with CPA among patients with cancer and autoimmune disease.
This is a national cross-sectional self-administered anonymous electronic survey conducted among recipients of CPA to cover the costs of a drug for cancer or autoimmune disease. Self-reported financial distress as measured by Comprehensive Score for Financial Toxicity as well as health care spending and experience with financial barriers to care were evaluated, as were perspectives on policy questions related to CPA and costs of care.
Among 1566 respondents (1108 with cancer and 458 with autoimmune disease, median age 71, 51% female, 89% White, 69% household income <$60,000), 53% reported mild and 31% moderate/severe financial distress, despite CPA. Eighteen percent reported missing recommended care because of costs. Most respondents (96%) had Medicare, 55% reported supplemental insurance, and 66% believed that insurance would prevent them from facing high costs of health care. A total of 52% reported paying more than $100 monthly in drug costs and 41% spending more than 10% of monthly income on health care. Financial distress was similar among patients with cancer and autoimmune diseases. In multivariable regression analysis, younger age, less education, unemployment, higher comorbidity, and lower income were independently associated with higher financial distress.
This study informs policy debate over the role of CPA foundations in the U.S. health insurance safety net and highlights the inadequacy of Medicare to guarantee access to care for older patients with chronic illness.
关于慈善共付援助（CPA）在解决医疗服务可及性和经济困境方面所起的作用，人们了解甚少。本研究旨在评估癌症和自身免疫性疾病患者的经济困境以及他们接受CPA的经历。
这是一项全国性的横断面自填式匿名电子调查，调查对象为接受CPA以支付癌症或自身免疫性疾病药物费用的人群。评估了通过金融毒性综合评分衡量的自我报告的经济困境、医疗保健支出以及就医经济障碍经历，还评估了对与CPA和医疗费用相关政策问题的看法。
在1566名受访者中（1108名癌症患者和458名自身免疫性疾病患者，中位年龄71岁，51%为女性，89%为白人，69%家庭收入低于6万美元），尽管有CPA，仍有53%报告有轻度经济困境，31%报告有中度/重度经济困境。18%报告因费用而错过推荐的治疗。大多数受访者（96%）有医疗保险，55%报告有补充保险，66%认为保险可使他们避免面临高额医疗费用。共有52%报告每月药物费用支出超过100美元，41%报告医疗保健支出超过月收入的10%。癌症患者和自身免疫性疾病患者的经济困境相似。在多变量回归分析中，年龄较小、教育程度较低、失业、合并症较多和收入较低与较高的经济困境独立相关。
本研究为关于CPA基金会在美国医疗保险安全网中作用的政策辩论提供了信息，并突出了医疗保险在保障老年慢性病患者获得医疗服务方面的不足。
