OBJECTIVES: Out-of-pocket (OOP) costs can represent a significant financial burden to patients diagnosed with cancer. Cancers diagnosed and treated at earlier stages may be associated with decreased morbidity and mortality as well as lower costs, including OOP costs. To better understand economic burden to patients by stage of cancer diagnosis, OOP costs were estimated following a cancer diagnosis.

METHODS: A retrospective analysis was conducted with Optum’s de-identified Integrated Claims-Clinical dataset with Enriched Oncology, which includes data from Medicare and commercially insured members (1/1/2008-7/31/2020). Adult members with staged breast (BC), colorectal (CRC), lung (LC), or ovarian cancer (OC), newly diagnosed between 1/1/2016-6/30/2020 and continuously enrolled for ≥1-month post-diagnosis were included. Mean OOP costs (co-pay + coinsurance + deductible) (2020 USD) from commercial claims were calculated in each month (if continuous enrollment and no death in the month) over a 1-year period post-cancer diagnosis. Claims associated with non-commercial insurance were not included. Mean annual total cost per patient was estimated by summing month 1-12 mean costs and stratifying by stage at cancer diagnosis.

RESULTS: 6,010 eligible members were identified that were diagnosed 2016-2020 with BC, CRC, LC, or OC. Mean year 1 commercial OOP costs generally increased by stage at diagnosis (mean cost difference stage I to IV, all cancers: p<0.001). Absolute mean commercial OOP cost increased from stage I to IV in BC by +$2,369, reflecting a 26% increase; CRC by +$1,213 (13% increase); LC by +$6,306 (76% increase); and OC by +$3,273 (49% increase). Mean OOP costs for Medicare Advantage patients demonstrated similar trends of increasing cost by stage.

CONCLUSION: Mean annual commercial OOP costs per patient during the year post cancer diagnosis were significantly higher among those diagnosed at later cancer stages. Earlier cancer diagnosis may enable more efficient treatment and reduce OOP patient burden.