Actionable Insights Newsletter

Translating research to power whole health

Issue 5    |    April 2023

Impact of deductible levels in patterns of breast cancer care and outcomes during post-ACA era

Findings suggest deductible levels have little impact on breast cancer care during two years following diagnosis.

Enterprise Analytics Core domain(s): Oncology, costs of care, quality of care, policy guidance, member experience

Summary

Background
The emergence of novel treatment agents and increasing enrollment in high-deductible health plans (HDHPs) have resulted in increased cumulative out-of-pocket spending among breast cancer patients in recent years. This study evaluated the impact of high vs. low health plan deductibles on breast cancer healthcare resource utilization (HCRU). 

Methods
This retrospective observational cohort study used multiple integrated longitudinal databases within the Healthcare Integrated Research Database. The study sample consisted of adult women with a first breast cancer diagnosis between January 2015 and December 2016. To be included in the study, patients were required to have continuous enrollment for at least one year before and two years after the diagnosis. Two patient cohorts were compared: HDHP (≥$1000/year) and low-deductible health plan (LDHP) (≤$500/year). Outcomes evaluated included diagnostic care, treatment patterns, all-cause HCRU and costs between cohorts while other key clinical determinants were netted out.

Results

• This study showed that there were no significant differences in screening, diagnostic care, and treatment utilization between HDHP and LDHP cohorts during the two years after diagnosis.
  
• HDHP cohort patients were less likely to receive a diagnostic magnetic resonance imaging (MRI) (p<0.01) or incorporate granulocyte colony-stimulating factor (G-CSF), a high-cost supportive care medication, into the first-line therapy (p=0.01).
• All-cause total healthcare costs (plan + patient paid) peaked in the first four months in both cohorts, likely driven by patients reaching the out-of-pocket spending limits soon after diagnosis (Figure 1). Total healthcare costs did not differ in the first year of follow-up. On average, HDHP patients incurred lower healthcare costs of $5,873 (p=0.03) in the second year of follow-up — driven by fewer physician office visits.

Key takeaways