Fiala Mark Aaron, Ji Mengmeng, Slade Michael, Huber John H, Shih Yi-Hsuan, Wang Mei, Colditz Graham A, Wang Shi-Yi, Vij Ravi, Chang Su-Hsin
Division of Oncology, Washington University School of Medicine, St Louis, MO.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO.
JCO Oncol Pract. 2025 May 12:OP2400978. doi: 10.1200/OP-24-00978.
This study aimed to determine if high-deductible health plan (HDHP) enrollment contributes to financial burden and hinders access to care for patients with multiple myeloma (MM).
Patients diagnosed with MM from 2010 to 2020 were identified in Merative MarketScan, an employer-based health insurance database. Primary outcomes were total health care and out-of-pocket (OOP) costs in the year after diagnosis. Secondary outcomes included time to treatment initiation and stem-cell transplant receipt. Multivariable analyses using linear, logistic, and Cox regression were performed, as appropriate. Covariates included age, sex, year diagnosed, comorbidities, data provider, and stem-cell transplant receipt.
The cohort included 4,029 patients; 17.6% were enrolled on HDHPs. HDHP enrollees were younger (mean age, 54.9 55.5 years; = .036). Over the first year, mean total and OOP costs were $406,401 in US dollars (USD) and $9,220 USD for HDHP enrollees, respectively, versus $386,802 USD ( = .027) and $7,021 USD ( < .001) for the standard plan enrollees. There was no statistically significant difference in total cost (β = 11; = .999) but mean OOP costs were $2,544 USD (β = 2,544; < .001) higher for HDHP enrollees after adjusting for covariates. The additional OOP costs incurred in the first 2 months, presumably because of deductibles, and after the deductible reset. Contrary to our hypothesis, HDHPs enrollees had shorter time to treatment initiation (median, 20 22 days; hazard ratio, 1.18; < .001) and were more likely to receive a stem-cell transplant (55.1% 47.6%; odds ratio, 1.25; = .010), after adjusting for covariates.
Compared with standard plan enrollees, OOP costs were higher for HDHP enrollees in the year after diagnosis, but HDHP enrollment was not associated with delays in treatment initiation or reduced access to stem-cell transplant.
本研究旨在确定参加高免赔额健康计划（HDHP）是否会加重多发性骨髓瘤（MM）患者的经济负担并阻碍其获得医疗服务。
在基于雇主的健康保险数据库Merative MarketScan中识别出2010年至2020年期间被诊断为MM的患者。主要结局为诊断后一年的总医疗费用和自付费用。次要结局包括开始治疗的时间和接受干细胞移植的情况。酌情进行了使用线性、逻辑和Cox回归的多变量分析。协变量包括年龄、性别、诊断年份、合并症、数据提供者和接受干细胞移植的情况。
该队列包括4029名患者；17.6%参加了HDHP。参加HDHP的患者更年轻（平均年龄，54.9对55.5岁；P = 0.036）。在第一年，参加HDHP的患者的平均总费用和自付费用分别为406,401美元和9220美元，而标准计划参保者分别为386,802美元（P = 0.027）和7021美元（P < 0.001）。调整协变量后，总费用无统计学显著差异（β = 11；P = 0.999），但参加HDHP的患者的平均自付费用高2544美元（β = 2544；P < 0.001）。在最初2个月以及免赔额重置后产生了额外的自付费用，可能是由于免赔额所致。与我们的假设相反，调整协变量后，参加HDHP的患者开始治疗的时间更短（中位数，20对22天；风险比，1.18；P < 0.001），并且更有可能接受干细胞移植（55.1%对47.6%；优势比，1.25；P = 0.010）。
与标准计划参保者相比，参加HDHP的患者在诊断后一年的自付费用更高，但参加HDHP与开始治疗的延迟或获得干细胞移植的机会减少无关。
