Oral Presentation Cancer Survivorship 2019

Patient out-of-pocket medical expenses over two years among Queenslanders with and without a major cancer (#7)

Louisa G Gordon 1 , Thomas M Elliott 1 , Catherine M Olsen 1 , Nirmala Pandeya 1 , David C Whiteman 1
  1. QIMR Berghofer Medical Research Institute, Herston, QUEENSLAND, Australia

Background: Patients with certain diseases such as cancer may be more vulnerable to high medical costs owing to the complexity of diagnosis and treatment. We determined the extent of and factors associated with out-of-pocket medical expenses among Australians newly diagnosed with one of five common cancers. Further, we explored if individuals with cancer had higher or lower expenses than individuals without cancer.

Methods: During 2010-11, 419 participants from the QSkin Study (n=43,794) had a confirmed diagnosis of either melanoma, prostate, breast, colorectal or lung cancer. These were matched to a general population group (n=421) and a group of high users of general practitioner (GP) services (n=419). Medical fees charged and out-of-pocket medical expenses for Medicare services were analysed. As cost data are typically right skewed, we tested differences in unadjusted mean costs using non-parametric bootstrapping and used generalised linear modelling to identify determinants of high costs.

Results: Over two years, median provider fees were $9,821 for the cancer group (75th percentile $20,551), $6,332 for the high GP user group (75th percentile $10,995) and $2,933 (75th percentile $6,394). Out-of-pocket expenses were significantly higher for those with cancer (mean $3,514) compared with the high GP user group (mean $1,837) and general population group ($1,245). Highest expenses for individuals with cancer were for therapeutic procedures (mean $2,062). We found breast and prostate cancer to have the highest out-of-pocket expenses of the five major cancers studied. Older individuals, those with poor perceived health or private health insurance had the highest costs.

Conclusion: Individuals with one of the main five cancers pay significantly higher out-of-pocket costs for health care compared with those without cancer even after adjustment for socio-demographic factors and irrespective of private health insurance status.