1. Out-of-pocket healthcare expenditures for cancer patients in the United States: Findings from the Medical Expenditure Panel Survey Lisa M. Lines, MPH 1,2 1 Boston Health Economics, Inc., Waltham, MA USA 2 University of Massachusetts Amherst, Amherst, MA USA Presented at the 9th Annual Health Services and Outcomes Research Conference, Houston, TX, December 3, 2008 Background and Objectives Methods  This study included all respondents with known ages, incomes, and insurance status in MEPS between 1996 and 2005 who had a cancer diagnosis (ICD-9-CM codes 140-239) recorded for at least 1 pharmacy, inpatient, outpatient, office, home health, or ER event during a 12-month time period  Data from all 10 years were pooled and weighted (using the year-specific MEPS person-weight variables) to create nationally representative, “average annual” estimates  Descriptive analyses of demographics, socioeconomics, and insurance status were performed –Individuals were categorized as uninsured if they were not covered by Medicare, Medicaid, other public programs, private insurance, or TRICARE during 1 or more months during the year  Total annual family income and person-level total and OOP expenditures (in 2007 US$) were calculated –Family incomes were calculated by summing the incomes of all persons in a household who were identified as being in the same family (using the CPSFAMID variable) and categorized by poverty category as follows: low income: 400% of FPL  Patient-level OOP expenditures were calculated, including copayment or coinsurance expenditures, deductibles, payments for non-covered expenses, and monthly insurance premiums –Part B premiums were added to OOP expenditures for Medicare enrollees using published year-specific data; 6 premiums for dual eligibles were assumed to be covered by Medicaid –OOP expenditures for privately insured individuals included actual monthly premiums paid for respondents in the years 2001-2005 and averages from those years applied to respondents in 1996-2000 (premium data were not collected in 1997- 99)  As in previous studies, individuals were defined as having a high OOP burden if their OOP expenditures exceeded 10% of family income (or 5% if low income), including monthly insurance premiums 1,7 Results  A total of 10,048 individuals with a cancer event were included (mean age=54.7; 88% white; 23% low income) (Table 1)  Approximately 48% were privately insured, 25% had both Medicare and private insurance, 14% had Medicare only, 5% had Medicaid and/or another form of public insurance, and 8% were uninsured (Table 1)  Overall, approximately 41% of individuals had a high OOP burden (Figure 1)  The percent with high burden was highest among those with both Medicare and private insurance or Medicare only (Figure 1)  Mean family income was $73,204, and annual OOP expenditures totaled $5,775, or 8% of family income (Table 2)  The bulk of OOP expenditures were for monthly insurance premiums (75%); about 11% of expenditures went toward prescription drugs (Table 2)  In unadjusted analyses, older and low-income individuals were most likely to have a high burden (Figure 2)  Persons with cancer were nearly twice as likely as those without cancer to have a high burden (Figure 3) 1.Merlis M, Gould D, Mahato B. Rising out-of-pocket spending for medical care: a growing strain on family budgets. 2006. http://www.commonwealthfund.org/usr_doc/Merlis_risingoopspending_887.pdf. Accessed November 18, 2008. 2.Banthin JS, Bernard DM. Changes in financial burdens for health care: national estimates for the population younger than 65 years, 1996 to 2003. JAMA. 2006;296:2712-2719. 3.Bernard DM, Banthin JS, Encinosa WE. Health care expenditure burdens among adults with diabetes in 2001. Med Care. 2006;44:210-215. 4.Howard DH, Molinari N, Thorpe KE. National estimates of medical costs incurred by nonelderly cancer patients. Cancer. 2004;100:891. 5.Langa KM, Fendrick AM, Chernew ME, et al. Out-of-pocket health-care expenditures among older Americans with cancer. Value Health. 2004;7:186-194. 6.US Census Bureau. Poverty thresholds for 2007 by size of family and number of related children under 18 years. 2008. http://www.census.gov/hhes/www/poverty/threshld/thresh07.html. Accessed August 4, 2008. 7.Centers for Medicare and Medicaid Services (CMS). Annual report of the Boards of Trustees. 2007. http://www.cms.hhs.gov/reportstrustfunds/downloads/tr2007.pdf, Table V.C2. Accessed November 18, 2008. 8.Schoen C, Collins SR, Kriss JL, Doty MM. How many are underinsured? Trends among U.S. adults, 2003 and 2007. Health Aff (Millwood). 2008 Jul-Aug;27(4):w298-309. References Conclusions  Among individuals with cancer, the average OOP expenditure, including monthly insurance premiums, was $5,775, and over 40% of individuals had a high OOP burden  The proportion of individuals with a high OOP burden was highest among low-income and older individuals and those with Medicare plus private insurance  Because cancer patients with high OOP burdens may have difficulty receiving optimal treatment, it is important to explore ways to reduce OOP expenditures for these individuals  There is an increasing focus on the impact of out-of-pocket (OOP) medical expenditures on individuals in the US healthcare system  From 1996 to 2002, OOP medical spending increased by 35%—faster than overall medical spending; meanwhile, incomes rose by only about 20% over the same period 1  Cancer patients are disproportionately affected by high OOP burdens –Today, most cancer care is performed in the outpatient oncology setting, which may expose patients to a greater share of total costs than in the past –Improvements in treatment and survival have led to more patients living with cancer as a chronic condition  Having a high OOP burden may put patients at risk of nonadherence to prescribed treatment, of opting out of receiving treatment perceived as too expensive, or of not being offered the treatment  Previous studies on OOP spending by cancer patients have presented the results of analyses limited to specific populations (elderly vs. nonelderly) or years 2-5  The purpose of this study was to describe the OOPEs of cancer patients in the US using a population-based approach Table 1: Demographics of individuals receiving care for cancer Table 2: Annual income, OOP expenditures, and share of family income, overall and by payor Figure 2: Percent with high OOP burden by income and age group Figure 3: Comparison of percent with high burden, general population and cancer population Figure 1: Percent with high OOP burden, by payor