Drivers of cost differences between US breast cancer survivors with or without lymphedema

Lorraine Dean, Yusuf Ransome, Livia Frasso-Jaramillo, Shadiya L. Moss, Yuehan Zhang, Kimlin Ashing, Gerald V. Denis, Kevin Frick, Kala Visvanathan, Kathryn H. Schmitz

Research output: Contribution to journalArticle

Abstract

Purpose: Breast cancer–related lymphedema is an adverse effect of breast cancer surgery affecting nearly 30% of US breast cancer survivors (BCS). Our previous analysis showed that, even 12 years after cancer treatment, out-of-pocket healthcare costs for BCS with lymphedema remained higher than for BCS without lymphedema; however, only half of the cost difference was lymphedema-related. This follow-up analysis examines what, above and beyond lymphedema, contributes to cost differences. Methods: This mixed methods study included 129 BCS who completed 12 monthly cost diaries in 2015. Using Cohen’s d and multivariable analysis, we compared self-reported costs across 13 cost categories by lymphedema status. We elicited quotes about specific cost categories from in-person interviews with 40 survey participants. Results: Compared with BCS without lymphedema, BCS with lymphedema faced 122% higher mean overall monthly direct costs ($355 vs $160); had significantly higher co-pay, medication, and other out-of-pocket costs, lower lotion costs; and reported inadequate insurance coverage and higher costs that persisted over time. Lotion and medication expenditure differences were driven by BCS’ socioeconomic differences in ability to pay. Conclusions: Elevated patient costs for BCS with lymphedema are for more than lymphedema itself, suggesting that financial coverage for lymphedema treatment alone may not eliminate cost disparities. Implications for Cancer Survivors: The economic challenges examined in this paper have long been a concern of BCS and advocates, with only recent attention by policy makers, researchers, and providers. BCS identified potential policy and programmatic solutions, including expanding insurance coverage and financial assistance for BCS across socioeconomic levels.

Original languageEnglish (US)
JournalJournal of Cancer Survivorship
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Lymphedema
Survivors
Breast Neoplasms
Costs and Cost Analysis
Health Expenditures
Insurance Coverage
Administrative Personnel
Health Care Costs
Neoplasms
Breast
Economics
Research Personnel

Keywords

  • Breast cancer
  • Economic burden
  • Financial toxicity
  • Lymphedema

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)

Cite this

Dean, L., Ransome, Y., Frasso-Jaramillo, L., Moss, S. L., Zhang, Y., Ashing, K., ... Schmitz, K. H. (Accepted/In press). Drivers of cost differences between US breast cancer survivors with or without lymphedema. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-019-00799-1

Drivers of cost differences between US breast cancer survivors with or without lymphedema. / Dean, Lorraine; Ransome, Yusuf; Frasso-Jaramillo, Livia; Moss, Shadiya L.; Zhang, Yuehan; Ashing, Kimlin; Denis, Gerald V.; Frick, Kevin; Visvanathan, Kala; Schmitz, Kathryn H.

In: Journal of Cancer Survivorship, 01.01.2019.

Research output: Contribution to journalArticle

Dean, Lorraine ; Ransome, Yusuf ; Frasso-Jaramillo, Livia ; Moss, Shadiya L. ; Zhang, Yuehan ; Ashing, Kimlin ; Denis, Gerald V. ; Frick, Kevin ; Visvanathan, Kala ; Schmitz, Kathryn H. / Drivers of cost differences between US breast cancer survivors with or without lymphedema. In: Journal of Cancer Survivorship. 2019.
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abstract = "Purpose: Breast cancer–related lymphedema is an adverse effect of breast cancer surgery affecting nearly 30{\%} of US breast cancer survivors (BCS). Our previous analysis showed that, even 12 years after cancer treatment, out-of-pocket healthcare costs for BCS with lymphedema remained higher than for BCS without lymphedema; however, only half of the cost difference was lymphedema-related. This follow-up analysis examines what, above and beyond lymphedema, contributes to cost differences. Methods: This mixed methods study included 129 BCS who completed 12 monthly cost diaries in 2015. Using Cohen’s d and multivariable analysis, we compared self-reported costs across 13 cost categories by lymphedema status. We elicited quotes about specific cost categories from in-person interviews with 40 survey participants. Results: Compared with BCS without lymphedema, BCS with lymphedema faced 122{\%} higher mean overall monthly direct costs ($355 vs $160); had significantly higher co-pay, medication, and other out-of-pocket costs, lower lotion costs; and reported inadequate insurance coverage and higher costs that persisted over time. Lotion and medication expenditure differences were driven by BCS’ socioeconomic differences in ability to pay. Conclusions: Elevated patient costs for BCS with lymphedema are for more than lymphedema itself, suggesting that financial coverage for lymphedema treatment alone may not eliminate cost disparities. Implications for Cancer Survivors: The economic challenges examined in this paper have long been a concern of BCS and advocates, with only recent attention by policy makers, researchers, and providers. BCS identified potential policy and programmatic solutions, including expanding insurance coverage and financial assistance for BCS across socioeconomic levels.",
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AU - Dean, Lorraine

AU - Ransome, Yusuf

AU - Frasso-Jaramillo, Livia

AU - Moss, Shadiya L.

AU - Zhang, Yuehan

AU - Ashing, Kimlin

AU - Denis, Gerald V.

AU - Frick, Kevin

AU - Visvanathan, Kala

AU - Schmitz, Kathryn H.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Breast cancer–related lymphedema is an adverse effect of breast cancer surgery affecting nearly 30% of US breast cancer survivors (BCS). Our previous analysis showed that, even 12 years after cancer treatment, out-of-pocket healthcare costs for BCS with lymphedema remained higher than for BCS without lymphedema; however, only half of the cost difference was lymphedema-related. This follow-up analysis examines what, above and beyond lymphedema, contributes to cost differences. Methods: This mixed methods study included 129 BCS who completed 12 monthly cost diaries in 2015. Using Cohen’s d and multivariable analysis, we compared self-reported costs across 13 cost categories by lymphedema status. We elicited quotes about specific cost categories from in-person interviews with 40 survey participants. Results: Compared with BCS without lymphedema, BCS with lymphedema faced 122% higher mean overall monthly direct costs ($355 vs $160); had significantly higher co-pay, medication, and other out-of-pocket costs, lower lotion costs; and reported inadequate insurance coverage and higher costs that persisted over time. Lotion and medication expenditure differences were driven by BCS’ socioeconomic differences in ability to pay. Conclusions: Elevated patient costs for BCS with lymphedema are for more than lymphedema itself, suggesting that financial coverage for lymphedema treatment alone may not eliminate cost disparities. Implications for Cancer Survivors: The economic challenges examined in this paper have long been a concern of BCS and advocates, with only recent attention by policy makers, researchers, and providers. BCS identified potential policy and programmatic solutions, including expanding insurance coverage and financial assistance for BCS across socioeconomic levels.

AB - Purpose: Breast cancer–related lymphedema is an adverse effect of breast cancer surgery affecting nearly 30% of US breast cancer survivors (BCS). Our previous analysis showed that, even 12 years after cancer treatment, out-of-pocket healthcare costs for BCS with lymphedema remained higher than for BCS without lymphedema; however, only half of the cost difference was lymphedema-related. This follow-up analysis examines what, above and beyond lymphedema, contributes to cost differences. Methods: This mixed methods study included 129 BCS who completed 12 monthly cost diaries in 2015. Using Cohen’s d and multivariable analysis, we compared self-reported costs across 13 cost categories by lymphedema status. We elicited quotes about specific cost categories from in-person interviews with 40 survey participants. Results: Compared with BCS without lymphedema, BCS with lymphedema faced 122% higher mean overall monthly direct costs ($355 vs $160); had significantly higher co-pay, medication, and other out-of-pocket costs, lower lotion costs; and reported inadequate insurance coverage and higher costs that persisted over time. Lotion and medication expenditure differences were driven by BCS’ socioeconomic differences in ability to pay. Conclusions: Elevated patient costs for BCS with lymphedema are for more than lymphedema itself, suggesting that financial coverage for lymphedema treatment alone may not eliminate cost disparities. Implications for Cancer Survivors: The economic challenges examined in this paper have long been a concern of BCS and advocates, with only recent attention by policy makers, researchers, and providers. BCS identified potential policy and programmatic solutions, including expanding insurance coverage and financial assistance for BCS across socioeconomic levels.

KW - Breast cancer

KW - Economic burden

KW - Financial toxicity

KW - Lymphedema

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