Background
Communicating healthcare costs to patients is an important component of delivering
high-quality value-based care, yet cost data are lacking. This is especially relevant
for ovarian cancer, where no clinical consensus on optimal first-line treatment exists.
Objective
The objective of this study was to generate cost estimates of different primary management
strategies in ovarian cancer.
Study Design
All women who underwent treatment for ovarian cancer from 2006–2015 were identified
from the MarketScan database (n=12,761) in this observational cohort study. Total
and out-of-pocket costs were calculated with the use of all claims within 8 months
from initial treatment and normalized to 2017 US dollars. The generalized linear model
method was used to assess cost by strategy.
Results
Among patients who underwent neoadjuvant chemotherapy and those who underwent primary
debulking, mean adjusted total costs were $113,660 and $107,153 (P<.001) and mean out-of-pocket costs were $2519 and $2977 (P<.001), respectively. Total costs for patients who had intravenous standard, intravenous
dose-dense, and intraperitoneal/intravenous chemotherapy were $105,047, $115,099,
and $121,761 (P<.001); and out-of-pocket costs were $2838, $3405, and $2888 (P<.001), respectively. Total costs for regimens that included bevacizumab were higher
than those without it ($171,468 vs $104,482; P<.001); out-of-pocket costs were $3127 vs $2898 (P<.001). Among patients who did not receive bevacizumab, 25% paid ≥$3875, and 10% paid
≥$6265. For patients who received bevacizumab, 25% paid ≥$4480, and 10% paid ≥$6635.
Among patients enrolled in high-deductible health plans, median out-of-pocket costs
were $4196, with 25% paying ≥$6680 and 10% paying ≥$9751.
Conclusion
Costs vary across different treatment strategies, and patients bear a significant
out-of-pocket burden, especially those enrolled in high-deductible health plans.
Key words
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References
- Projected National Health Expenditure.(Available at:)
- The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience.Oncologist. 2013; 18: 381-390
- The state of cancer care in America, 2017: a report by the American Society of Clinical Oncology.J Oncol Pract. 2017; 13: e353-e394
- Financial insolvency as a risk factor for early mortality among patients with cancer.J Clin Oncol. 2016; 34: 980-986
- Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer.J Clin Oncol. 2016; 34: 1732-1740
- Delivering high-quality cancer care: charting a new course for a system in crisis.The National Academies Press, Washington (DC)2013
- Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer.N Engl J Med. 2010; 363: 943-953
- Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): a randomised, controlled, open-label trial.Lancet Oncol. 2013; 14: 1020-1026
- Intraperitoneal cisplatin and paclitaxel in ovarian cancer.N Engl J Med. 2006; 354: 34-43
- Incorporation of bevacizumab in the primary treatment of ovarian cancer.N Engl J Med. 2011; 365: 2473-2483
- NCCN guidelines for ovarian, fallopian tube, and primary peritoneal cancer treatment regimens.(Available at:)https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdfDate accessed: December 18, 2018
- Truven Health Analytics MarketScan database.(Available at:)https://truvenhealth.com/markets/life-sciences/products/data-tools/marketscan-databasesDate accessed: December 3, 2018
- Utilization and toxicity of alternative delivery methods of adjuvant chemotherapy for ovarian cancer.Obstet Gynecol. 2016; 127: 985-991
- Data sources for measuring comorbidity: a comparison of hospital records and medicare claims for cancer patients.Med Care. 2006; 44: 921-928
- Measuring price change for medical care in the CPI. Consumer price index. Washington, DC: Division of Consumer Prices and Price Indexes, U.S. Bureau of Labor Statistics.(Available at:)https://www.bls.gov/cpi/factsheets/home.htmDate accessed: December 25, 2018
- Projections of the cost of cancer care in the United States: 2010-2020.J Natl Cancer Inst. 2011; 103: 117-128
- American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options.J Clin Oncol. 2015; 33: 2563-2577
- We Won’t Get Value-Based Health Care Until We Agree on What “Value” Means.(Available at:)https://hbr.org/2018/02/we-wont-get-value-based-health-care-until-we-agree-on-what-value-meansDate accessed: December 25, 2018
- The cost of initial care for medicare patients with advanced ovarian cancer.J Natl Compr Canc Netw. 2016; 14: 429-437
- Costs of treatment for elderly women with advanced ovarian cancer in a Medicare population.Gynecol Oncol. 2015; 137: 479-484
- Cost of care for the initial management of ovarian cancer.Obstet Gynecol. 2017; 130: 1269-1275
- A phase 3 trial of bevacizumab in ovarian cancer.N Engl J Med. 2011; 365: 2484-2496
- A cost-utility analysis of NRG Oncology/Gynecologic Oncology Group protocol 218: incorporating prospectively collected quality-of-life scores in an economic model of treatment of ovarian cancer.Gynecol Oncol. 2015; 136: 293-299
- Discussing health care expenses in the oncology clinic: analysis of cost conversations in outpatient encounters.J Oncol Pract. 2017; 13: e944-e956
Article Info
Publication History
Published online: April 24, 2019
Accepted:
April 3,
2019
Received in revised form:
April 1,
2019
Received:
January 14,
2019
Footnotes
Supported in part by the Duncan Family Institute , a Cancer Center Support Grant (CCSG) for National Cancer Institute–designated Cancer Centers (#CA016672), and a National Cancer Institute grant ( #P30 CA016672 ); by a National Institutes of Health T32 grant ( #5T32 CA101642 ) to R.S.S.; by a National Cancer Institute K award ( #K07 CA201013 ) to L.A.M., and by a Cancer Prevention and Research Institute of Texas grant ( #RP160674 ) and Komen grant ( #SAC150061 ) to S.H.G.
Dr Meyer has received research support from AstraZeneca and has been a consultant for Clovis Oncology. Dr Sun has received research support from AstraZeneca. The remaining authors report no conflict of interest.
Cite this article as: Suidan RS, He W, Sun CC, et al. Total and out-of-pocket costs of different primary management strategies in ovarian cancer. Am J Obstet Gynecol 2019;221:136.e1-9.
Identification
Copyright
© 2019 Published by Elsevier Inc.
