Oncologists must address costs with their patients
February 2015 Vol 8, Special Issue: Payers' Perspectives in Oncology - Health Economics
Kate Smith

San Francisco, CA—The cost of paying for cancer impacts the efficacy of treatment, according to S. Yousuf Zafar, MD, MHS, Associate Professor of Medicine, Duke Cancer Institute, Durham, NC. High patient cost burden is associated with a 70% higher likelihood of a patient’s nonadherence to treatment, Dr Zafar said at the ASH 2014 special session on drug pricing.
Dr Zafar coined the now-familiar concept of “financial toxicity,” which, he says, is as important as drug toxicity when it comes to patients with cancer. A patient’s inability to afford the cost of cancer therapy is as important to the patient’s health as potential drug toxicity.

Therefore, Dr Zafar urges oncologists to discuss costs with their patients to improve outcomes. Patient–physician communication about the cost reduces out-of-pocket (OOP) costs to patients, even in oncology, where treatment options are often limited, he says.

“It’s important for physicians to recognize that some patients are at risk for financial toxicity,” he said. His position is supported by the following statistics related to cancer care:

  • 50% of Medicare beneficiaries pay 10% of the cost OOP
  • 28% of Medicare beneficiaries spend >20% OOP
  • Nearly 50% of patients take money from their savings and cut back on basics to pay for care
  • The average patient spends approximately $5000 OOP
  • The average insurance deductible has risen from $584 in 2006 to $1217 in 2014
  • Since 2006, the cost of insurance premiums has risen by 182%, and employees’ contributions have gone up 128%
  • A cancer diagnosis raises the risk for bankruptcy nearly 3-fold.

Contributing to the rising cost for patients are 4-tiered formularies, which have become increasingly common. There were no fourth-tier drugs in 2003, but by 2013, approximately 23% of drugs were in the fourth tier. This usually includes all oral chemotherapy agents.

The cumulative cost of treatment to the patients not only impacts their emotional and financial health, but it can also compromise clinical outcomes, according to Dr Zafar.

Patient–Physician Discussions About Cost
In prospective, longitudinal studies of patients with cancer, Dr Zafar and colleagues have found that 52% of patients want to discuss treatment-related OOP costs with their oncologist, and 51% want their oncologist to take cost into account when making treatment decisions, but only 19% of patients have actually discussed these things with their doctors.

Among patients who did discuss costs, 57% report having lower OOP costs as a result, mainly because they were referred to a financial assistance organization (53%).

Other reasons for lower costs include physicians negotiating with insurance companies on the patient’s behalf (25%), patients switching to less expensive medications (19%), tests altered (13%), and office visits scaled back (6%), Dr Zafar said.

He emphasizes that cost issues do not get resolved in the absence of price transparency and discussions with patients. “We have to involve patients” in their care, Dr Zafar said. “I do this in the clinic every day.”

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Last modified: May 4, 2015
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