Cancer costs: who is bearing the burden?

Cancer care

By Geir O'Rourke

8 Jul 2024

There are calls for financial toxicity safeguards focused on private health fund members, amid data suggesting more than half of patients with cancer will face out-of-pocket costs exceeding $1000 in the first year after diagnosis.

While higher costs are associated with economic advantage, the finding indicates that money is becoming a potential barrier to health care access and impacting outcomes even for those with financial resources, researchers say.

The figures follow an analysis of data from the 45 and Up Study, which included NSW patients aged 45 years and older recruited in the mid-to-late 2000s.

Some 45,000 participants completed a follow-up questionnaire in 2020, 43% of whom reported their overall out-of-pocket health care expenses had exceeded $1000 in the previous year. These costs included medical, travel and drug expenses, but not private health insurance premiums.

Importantly, annual out-of-pocket costs were above that amount for 55% of the 861 patients who had been diagnosed with cancer in the previous two years.

Around 10% of these patients had expenses above $10,000, the study found.

“Our findings – based on data for a statewide sample including all cancer types and a broad range of cost types, and taking several key socio-demographic and clinical characteristics into account – indicate that out-of-pocket costs are potentially a barrier to equitable health care access and optimal health care outcomes for people with limited financial resources,” the authors wrote in the MJA (link here).

Breast and prostate cancer diagnoses were amongst the strongest predictors of high out-of-pocket costs, with those who had been diagnosed with prostate cancer in the past two years having eight times the odds spending above $10,000 on health care than those without cancer.

Interestingly, cancer-related out-of-pocket costs appeared to decline in the years after diagnosis, with cancer patients’ expenses roughly the same as those of other patients after two years, the study found.

The authors added that the relationship between higher out-of-pocket health care expenses, cancer, and socio-economic standing was a complex one, with higher costs associated with socio-economic advantage and having private health insurance.

“However, the potentially negative impact of out-of-pocket health care costs is not caused by their absolute level, but by their affordability, which is determined by a person’s financial resources,” they wrote.

“Evidence of financial toxicity in cancer care is growing; that is, the inability to pay for health care affects a person’s physical and psychological health, influences their health care decisions, and potentially leads to poorer outcomes.”

“Cost transparency can also be a problem.”

Finding raises questions around cancer cost burden

In an attached editorial, Professor Peter Gibbs and Dr Colin Williams of the Walter and Eliza Hall Institute brought into focus the health cost  burden borne by people with private insurance and higher socio-economic status (link here).

Not only did these patients face substantial and increasing costs of private health insurance, they were also confronted with out-of-pocket gaps associated with common medical procedures, which were clearly increasing, the authors wrote.

“To have contributed to private insurance and then be faced with major additional costs is confronting, particularly when considering the lower costs for a person receiving the same treatment in a public hospital.”

“Further, in addition to any gap payments, additional costs can be incurred with the use of newer surgical or radiation oncology technology, or medications not readily available to public patients.”

“Such therapies are supported by varying levels of clinical evidence. The strongest association with out-of-pocket costs exceeding $10 000 was a recent breast or prostate diagnosis, which may suggest where higher costs are being incurred.”

The authors said the findings underscored the importance of informed consent, particularly when emerging treatment options were discussed with high out-of-pocket costs.

“Fully informed decision making is always important, but particularly when highly stressed people are contemplating a life-threatening illness, when disease-related anxiety and the real or perceived urgency of commencing treatment may influence their decisions,” the authors wrote.

“Increasing out-of-pocket health care expenses, particularly for people with cancer, are clearly concerning, especially if they compromise the care of those who are unable to pay. Currently, out-of-pocket costs are more likely to be incurred by those with least disadvantage.”

“Given the inexorable rise in health care costs and the increasing challenge of making the best available treatments accessible to everyone, it is important to discuss cancer treatment costs for all patients. Here, as always, people should be fully informed in advance of costs and treatment alternatives, and efforts are needed to contain out-of-pocket expenses.”

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