Blood Cancers Associated With Higher Treatment and Out-of-Pocket Costs

Gwen L. Nichols, MD

Patients with blood cancers face greater treatment costs than those with solid tumors. Furthermore, healthcare spending for these patients is already higher than average before diagnosis and does not return to prediagnosis levels even after successful treatment, according to a study commissioned by the Leukemia & Lymphoma Society (LLS).¹ On average, per-patient spending in the first year after diagnosis topped $156,000, according to the Milliman research company, which conducted the study. The per-patient average ranged from nearly $89,000 for chronic leukemia to more than $460,000 for acute leukemia (Figure).¹ The figures in the report represent allowed spending, defined as costs paid by payers and patients combined, not including expenses not covered by insurance. Most of these costs are covered by payers, the report noted.

Spending over the 3 years following diagnosis varied from $200,000 for chronic leukemia to more than $800,000 for acute leukemia. This compared with an average cumulative 3-year cost of $250,000 for patients with lung cancer and approximately $150,000 for patients with colorectal cancer, prior data from Milliman studies indicated.

Before diagnosis, spending for patients with blood cancer was approximately $1600 per month compared with $343 per month for the average commercial insurance member without cancer. By the third year after diagnosis, healthcare spending averaged $3500 to $4500 per month for patients with blood cancer.

“We at LLS frequently hear from [patients with] blood cancer about the rising costs associated with lifesaving treatment,” Gwen L. Nichols, MD, chief medical officer of LLS, said in a statement. “As this new study shows, each player in the healthcare system has a role to play in lowering these costs so patients can access their care. Armed with [these] data, LLS looks forward to continuing to work with stakeholders across the oncology ecosystem on solutions that put patients at the forefront in addressing the unsustainable cost of cancer care.”

Although therapeutic advancements have improved outcomes for patients, the report noted, “increased survival is placing more pressure on payers to find efficiencies in care.” Five-year survival rates vary by disease, ranging from 66.5% for leukemia to 92.4% for Hodgkin lymphoma. Leukemia, the most common form of pediatric cancer, accounts for 29% of all cancers among patients aged 0 to 14 years.

Overall, the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program database reports that blood cancer—related deaths declined by more than 2% from 2011 to 2015. Study findings suggest that there are long-term costs associated with surveillance, long-term adverse effects of treatment, and recurrence for adults who successfully achieve remission, particularly for survivors of childhood cancer because they have the greatest life expectancy.

“Mitigating the blood cancer care burden to the healthcare system and on patients and their families requires all stakeholders to understand where the costs lie, especially for treatment paths that are unique to the blood cancers,” Milliman investigators wrote in the report. “In the United States in 2014, the year this study’s cohort was diagnosed, total healthcare expenditures for cancer were estimated to be $87 billion, with the largest expenditures paid for hospital outpatient or office-based provider visits (58%) and inpatient admissions (27%).”

To conduct the study, Milliman investigators collected real-world claims data from 2332 adults with blood cancer with commercial insurance who received an initial diagnosis in 2014. They then analyzed the amount total healthcare allowed spending and out-of-pocket (OOP) costs for patients with lymphoma (63%), chronic leukemia (12%), multiple myeloma (12%), acute leukemia (6%), and bone marrow disorders (6%).

Spending spiked in the month following diagnosis, driven primarily by inpatient hospital costs. The average in per-patient per-month (PPPM) allowed spending was less than $2000 two months prior to diagnosis compared with an average $28,838 PPPM in the month of diagnosis.

In terms of OOP spending, the amount that patients paid depended on the structure of their insurance plan, with higher costs accumulating during the month of diagnosis. Professional services accounted for most of OOP costs, including 35% within the first 12 months following diagnosis, and represented the highest portion of out-of-network service costs. Services delivered in the outpatient settings accounted for 25% of all OOP costs in the first 12 months.

After analyzing therapies, investigators found that stem cell transplantation accounted for as much as a quarter of allowed spending across the total patient population with blood cancer. Anticancer drug therapy made up one-third of all allowed spending.

The average patient with a blood cancer had more than $112,000 in annual allowed spending in 2016. Although patients aged 0 to 14 years made up the smallest patient cohort, they accounted for the highest average allowed spending, at roughly $160,000 per year. Patients aged 40 to 64 years, the age bracket in which a blood cancer diagnosis was most prevalent, had the lowest average annual costs, at $106,000.

“Insurance coverage does offer substantial protection to most of the patients in our [study]. However, some patients, especially those with high-deductible plans, will face financial toxicity,” the report concluded. “Payers can ameliorate some of these issues by trying to provide prompt financial counseling to affected individuals. Avoiding [out-of-network] charges can protect a patient’s financial resources. Plan design changes could help smooth the calendar year deductible spike. But the ultimate solution is to reduce healthcare cost and not to pass overly high costs to patients.”

Dieguez G, Ferro C, Rotter D; Milliman, Leukemia & Lymphoma Society. The cost burden of blood cancer care: a longitudinal analysis of com-mercially insured patients diagnosed with blood cancer. LLS.org. www.lls.org/sites/default/files/Milliman%20study%20cost%20burden%20of%20blood%20cancer%20care.pdf. October 2018. Accessed January 8, 2019. pdf. Published October 2018. Accessed November 25, 2018.