For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships

Banegas, Matthew P.; Guy, Gery P.; Moor, Janet S. de; Ekwueme, Donatus U.; Virgo, Katherine S.; Kent, Erin E.; Nutt, Stephanie; Zheng, Zhiyuan; Rechis, Ruth; Yabroff, K. Robin

doi:10.1377/hlthaff.2015.0830

Cited by 216 publications

(233 citation statements)

References 41 publications

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“…10, 24 Additionally, these individuals may also delay treatment initiation in the hope of receiving financial assistance from a patient assistance program or foundation. This may explain the longer time to initiation among individuals who were not receiving cost-sharing subsides.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Tyrosine Kinase Inhibitor Initiation and Adherence Among Medicare Beneficiaries With Chronic Myeloid Leukemia

Winn

Keating

Dusetzina

2016

JCO

105

111

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There is substantial concern surrounding affordability of orally administered anticancer therapies, particularly for Medicare beneficiaries. We examined rates of initiation and adherence to tyrosine kinase inhibitors (TKIs) among Medicare beneficiaries with chronic myeloid leukemia (CML) with and without cost-sharing subsidies. We selected TKIs given their effectiveness and strong indication for use among patients diagnosed with CML. Patients and MethodsUsing SEER-Medicare data, we identified individuals diagnosed with CML from 2007 to 2011. We used Cox proportional hazards regression to assess time from diagnosis to TKI initiation. We used generalized estimating equations to examine treatment initiation within 180 days and TKI adherence among initiators. We defined adherence as at least 80% of days covered during the 6 months after TKI initiation. Results Among 393 individuals diagnosed with CML from 2007 to 2011, 68% initiated TKI treatment within 180 days after diagnosis. In multivariate analysis, individuals with cost-sharing subsidies, younger age, lower comorbidity, and later year of diagnosis were significantly more likely to initiate TKIs. Among TKI initiators, 61% were adherent; adherence was lower for individuals age 80 years or older versus 66 to 69 years. ConclusionOnly 68% of Medicare beneficiaries with CML initiated TKI therapy within 6 months of diagnosis. Delayed initiation among individuals without cost-sharing subsidies suggests that out-of-pocket costs may be a barrier to timely initiation of therapy among individuals diagnosed with CML.

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Tyrosine Kinase Inhibitor Initiation and Adherence Among Medicare Beneficiaries With Chronic Myeloid Leukemia

Winn

Keating

Dusetzina

2016

JCO

105

111

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“…Our findings are salient for adult cancer survivors with greater number of comorbidities, whom tend to incur excess financial burden throughout survivorship and will likely continue to experience greater burden as the cost of cancer therapies increase [11,36]. Along with rising health-care costs [37], the affordability of care is also a major concern as the onus of medical costs have gradually shifted toward the patient with increasing deductibles, copayments, and use of coinsurance [11,36].…”

Section: Discussionmentioning

confidence: 99%

“…Along with rising health-care costs [37], the affordability of care is also a major concern as the onus of medical costs have gradually shifted toward the patient with increasing deductibles, copayments, and use of coinsurance [11,36]. Even with health insurance, cancer survivors and particularly those with a higher number of comorbidities will be vulnerable to the deductibles and out-of-pocket costs.…”

Section: Discussionmentioning

confidence: 99%

The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review

Rim

Guy

Yabroff

et al. 2016

Expert Review of Pharmacoeconomics & Outcomes Research

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Introduction This systematic review examines the excess cost of chronic conditions on the economic burden of cancer survivorship among adults in the US. Areas covered Twelve published studies were identified. Although studies varied substantially in populations, comorbidities examined, methods, and types of cost reported, costs for cancer survivors with comorbidities generally increased with greater numbers of comorbidities or an increase in comorbidity index score. Survivors with comorbidities incurred significantly more in total medical costs, out-of-pocket costs, and costs by service type compared to cancer survivors without additional comorbidities. Expert commentary Cancer survivors with comorbidities bear significant excess out-of-pocket costs and their care is also more expensive to the healthcare system. On-going evaluation of different payment models, care coordination, and disease management programs for cancer survivors with comorbidities will be important in monitoring impact on healthcare costs.

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“…Severe financial distress after cancer diagnosis may also be a risk factor for mortality. 60,61 In the US, a heavy financial burden or "financial toxicity" is increasingly recognised as impacting QoL and treatment adherence in patients with cancer.…”

Section: Potential Impact Of Reaching the Sustainability Ceiling Of Cmentioning

confidence: 99%

What Happens when the Cost of Cancer Care Becomes Unsustainable?

Simoens¹,

Harten²,

Lopes³

et al. 2017

European Oncology &Amp; Haematology

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Cancer places a heavy burden on healthcare systems. The cost of cancer drugs is increasing, driven largely by the introduction of new, ever more innovative cancer treatments. This raises questions about value for money and the future sustainability of cancer care, and presents significant challenges for decision-makers in providing all patients with access to treatments and effective new cancer medicines. The aims of this article are to provide an understanding of how sustainability in cancer care is defined, what signs indicate that the limits of sustainability are being reached, and what potential impact this may have on patients with cancer within Europe. Each country is faced with making difficult decisions about the allocation of healthcare resources to cancer care, to best meet the health needs of their patients. Determining the value of individual cancer drugs can help to inform these decisions, because premium pricing for incremental innovation is no longer sustainable. When the cost of cancer care becomes unsustainable, countries may be forced to restrict health expenditure by limiting demand, cutting spending and reducing investment. This can lead to restricted access to treatment. New, innovative cancer treatments must provide greater value than current options, and measures are needed to contain and reduce expenditure and make best use of scarce resources, without impeding access to effective and safe treatments for all patients.

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For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships

Cited by 216 publications

References 41 publications

Factors Associated With Tyrosine Kinase Inhibitor Initiation and Adherence Among Medicare Beneficiaries With Chronic Myeloid Leukemia

Factors Associated With Tyrosine Kinase Inhibitor Initiation and Adherence Among Medicare Beneficiaries With Chronic Myeloid Leukemia

The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review

What Happens when the Cost of Cancer Care Becomes Unsustainable?

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