Rose Liam, Rajasekar Ganesh, Nambiar Anjali, Pohl Alexa, Ruddy Kathryn J, Arnow Katherine, Patel Manali, Morris Arden M
Stanford University School of Medicine, Palo Alto, California.
Department of Veterans Affairs, Palo Alto, California.
JAMA Netw Open. 2025 Jul 1;8(7):e2521575. doi: 10.1001/jamanetworkopen.2025.21575.
Cancer imposes a substantial economic burden on patients that may be worse in patients with higher-stage disease due to the need for more therapy.
To investigate the out-of-pocket costs (OOPCs) attributable to the initial treatment of common cancers among privately insured individuals diagnosed at different stages.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used administrative claims data of a large national insurer in the US linked to the Surveillance, Epidemiology, and End Results (SEER) cancer registry to compare OOPCs of individuals diagnosed with breast, colorectal, and lung cancer at different stages with OOPCs of similar individuals without cancer using difference-in-differences methods. Individuals living in the US between 2008 and 2022, aged younger than 65 years, insured through a large national private health insurer, and with 6 or more months of continuous enrollment were included. Data were analyzed from June 2024 through February 2025.
The presence or absence of an incident cancer diagnosis and disease stage from the SEER registry diagnosed from 2008 to 2019.
The primary outcome was OOPCs among individuals with breast, colorectal, and lung cancer diagnosed at different disease stages compared with those with no cancer diagnosis.
The cohort consisted of 46 158 patients (mean [SD] age at diagnosis, 46 [12] years; 30 733 female [66.6%]; 2543 Asian [5.5%], 4114 Black [8.9%], 3590 Hispanic [7.8%], and 31 099 White [67.4%]), including 19 656 patients with cancer and 26 502 patients without cancer in the control group. Among patients with cancer, 14 581 patients had breast cancer, 2842 patients had colorectal cancer, and 2233 patients had lung cancer. An incident cancer diagnosis was associated with a mean increase in OOPCs of $592.53 per month (95% CI, $528.01-$627.04 per month) for the 6 months after the diagnosis. Cost monotonically increased with stage at diagnosis (mean OOPC increase range, $462.01 per month [95% CI, $417.92-$506.11 per month] for stage 0 to $719.97 per month [95% CI, $626.11-$813.83 per month] for stage 4).
In this study of individuals with private insurance, patients faced high OOPCs after an incident diagnosis of cancer, with patients with more advanced cancer having the highest OOPCs. Further research is needed to determine the clinical and financial effects of increased OOPCs for patients with cancer.
癌症给患者带来了沉重的经济负担，对于疾病分期较晚的患者而言，由于需要更多治疗，这种负担可能更为严重。
调查不同分期诊断出的常见癌症患者在初次治疗时的自付费用（OOPC）。
设计、设置和参与者：这项回顾性队列研究使用了美国一家大型全国性保险公司的行政索赔数据，并与监测、流行病学和最终结果（SEER）癌症登记处相链接，采用差异法比较不同分期诊断出乳腺癌、结直肠癌和肺癌的个体与未患癌症的相似个体的OOPC。纳入了2008年至2022年间居住在美国、年龄小于65岁、通过大型全国性私人健康保险公司投保且连续参保6个月或更长时间的个体。数据于2024年6月至2025年2月进行分析。
2008年至2019年SEER登记处诊断出的癌症确诊情况及疾病分期。
主要结局是不同疾病分期诊断出乳腺癌、结直肠癌和肺癌的个体与未患癌症个体的OOPC。
该队列包括46158名患者（诊断时的平均[标准差]年龄为46[12]岁；30733名女性[66.6%]；2543名亚洲人[5.5%]，4114名黑人[8.9%]，3590名西班牙裔[7.8%]，31099名白人[67.4%]），其中包括19656名癌症患者和对照组中的26502名非癌症患者。在癌症患者中，14581名患有乳腺癌，2842名患有结直肠癌，2233名患有肺癌。确诊癌症与确诊后6个月内OOPC平均每月增加592.53美元（95%CI，每月528.01 - 627.04美元）相关。费用随诊断分期呈单调增加（0期的平均OOPC增加范围为每月462.01美元[95%CI，每月417.92 - 506.11美元]至4期的每月719.97美元[95%CI，每月626.11 - 813.83美元]）。
在这项针对私人保险个体的研究中，癌症确诊后患者面临高额OOPC，癌症分期越晚的患者OOPC最高。需要进一步研究以确定癌症患者OOPC增加的临床和经济影响。
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