Table 2.
Material measures of financial hardship: Out-of-pocket medical costs
| First author, y | Sample size (n) | Setting, data source, and time frame (duration of spending) | Measures | Key findings |
|---|---|---|---|---|
| Arozullah, 2004 (28) | 154 breast cancer survivors | Chicago; Northwestern University; 1999 to 2002 (3 mo) | OOP expenses related to direct medical, direct nonmedical, and indirect costs | Average monthly OOP and lost income costs of $1455 during a 3-mo period (y of dollars not stated); OOP expenditures for medications (80%), transportation (78%), physician visits (66%), and restaurant meals (51%) |
| Banthin, 2006 (29) | 7519 cancer survivors (all sites) | National; MEPS; 1996 and 2003 (annual) | Family OOP burden and family health care services OOP burden; spending >20% of income | Total annual family OOP burden (2003 US dollars): 28.8% paid >10% and, 11.4% paid >20% of disposable income; family health care services OOP burden: 16% paid >10% and 6.7% paid >20% of disposable income |
| Bernard, 2011 (30) | 4243 cancer survivors (all sites) | National; MEPS; 2001 to 2008 (annual) | OOP burden, high health care total burden of > 20% of income | Cancer survivors had annual OOP of $3881 (2008 dollars); high health care total burden in 13.4% of cancer survivors, 9.7% with and 4.4% without chronic conditions |
| Davidoff, 2013 (35) | 1868 cancer survivors (all sites) | National; MCBS; 1997 to 2007 (2 y) | Total OOP spending and OOP spending >20% of income | Beneficiaries with cancer paid $4727 (cumulative 2-y spending, 2007 US dollars) in OOP, while comparison group paid $3209; high OOP burden in 28% of cancer survivors and 16% of beneficiaries without a cancer history |
| Ekwueme, 2014 (7) | 6722 cancer survivors (all sites) | National; MEPS; 2008 to 2011 (annual) | OOP spending | Annual OOP expenditures: $751 for male cancer survivors, $600 for male controls, $973 for female cancer survivors, and $833 for female controls (2011 US dollars) |
| Finkelstein, 2007 (40) | 1940 cancer survivors (all sites) | National; MEPS; 2000 to 2005 (annual) | OOP expenditures | Annual OOP expenditures for cancer survivors in active care $870 higher than survivors not currently receiving treatment, and $1190 higher than those without a cancer history (2005 US dollars) |
| Guy, 2013 (6) | 4960 cancer survivors (all sites) | National; MEPS; 2008 to 2010 (annual) | OOP expenditures | For adults age 18–64 y, annual adjusted OOP expenditure was $1107 (2010 US dollars) for recently diagnosed, $747 for previously diagnosed, and $617 for no history of cancer; for age 65 y and older, annual adjusted OOP expenditure was $1711 for recently diagnosed, $1529 for previously diagnosed, and $1220 for no history of cancer |
| Guy, 2014 (41) | 1464 cancer survivors (all sites) | National; MEPS; 2008 to 2011 (annual) | OOP expenditures | Annual adjusted OOP expenditures for adult survivors of cancer diagnosed age 15–39 y was $765 (2011 US dollars) compared with $686 for adults without a cancer history |
| Guy, 2015 (42) | 4271 cancer survivors (all sites) | National; MEPS; 2008 to 2012 (annual) | Total annual OOP spending on healthcare >20% of annual income | Survivors were more likely to report a high OOP burden (4.3%) compared with those without a cancer history (3.4%) |
| Jacobsen, 2012 (45) | 3918 oral, oral pharyngeal, and salivary gland cancer survivors | National; Marketscan CCAE databases; 2004 to 2008 (annual) | OOP payments | Annual OOP payments for survivors with commercial insurance and Medicare were $2133 and $785 (2009 US dollars) more than for controls |
| Jagsi, 2014 (8) | 1502 breast cancer survivors | Los Angeles, CA, and Detroit, MI; SEER; 2005 to 2007 (4 y) | OOP expenditures | 65% of breast cancer survivors paid <$2000 in OOP expenditures, 18% paid $2001–<$5000 and 17% paid >$5000 (y of dollars not stated) |
| Jayadevappa, 2010 (46) | 512 prostate cancer patients | Urology clinics of an academic medical center and the Veterans Administration Medical Center; 2002 to 2005 (2 y) | OOP expenditures (medical costs and nonmedical costs) | OOP costs for patients receiving radical prostatectomy and radiation at 24-month follow-up were $330 and $661, respectively (y of dollars not stated) |
| Kilgore, 2007 (47) | 781 cancer survivors (all sites) | National; Cost of Cancer Treatment Study; y not stated (6 mo) | OOP expenditures for prescription drugs and other health care | No statistically significant difference in OOP expenditures for clinical trial participants compared with nonparticipants |
| Langa, 2004 (48) | 988 cancer survivors (all sites) | National; Health and Retirement Study; 1995 (2 y) | OOP expenditures for nursing home stays, outpatient services, home care and prescription medication | Adjusted annual OOP expenditures for the no cancer, cancer/no treatment, and cancer current treatment groups were $1210, $1450, and $1880, respectively (1995 US dollars); prescription medication ($1120) and home care services ($250) accounted for most of the additional OOP expenditures in treatment group |
| Li, 2014 (49) | 5944 cancer survivors (all sites) | National; MEPS; 2008 to 2011 (annual) | OOP expenditures for mental health | For cancer survivors age 18–64 and 65+ y, annual OOP MH expenditure was $13 and $28 (y of dollars not stated) |
| Meisenberg, 2015 (50) | 132 cancer survivors (all sites) | Single cancer institute in Annapolis, MD; y not stated (not listed) | OOP expenditures | Mean and median OOP costs for survivors were $938 and $250 monthly, respectively (y of dollars not listed) |
| Moore, 1998 (51) | 20 cancer survivors (all sites) | Single Midwest medical clinic; y not stated (not listed) | OOP expenditures for clinic visits, symptom and side effects, support/assistance, administrative, and quality of life | Mean OOP expenditures was $741 per month (range = $12–$3130; y of dollars not listed) |
| Pisu, 2011 (52) | 262 cancer survivors | Southern states; BCEI; y not stated (monthly) | Medical and nonmedical OOP costs | OOP costs were $316 per month (2008 US dollars); direct medical monthly OOP cost was $281, and direct nonmedical monthly OOP cost was $66 |
| Teitelbaum, 2013 (57) | 2642 multiple myeloma patients | National; Optuminsight (1 y after treatment episode*) | OOP costs, including copayment, coinsurance, and deductibles for three target agents: BOR, THAL, and LEN | Mean unadjusted OOP costs per episode for patients treated with agents: BOR ($3846) THAL ($4666), LEN ($4483), and other ($3900) per treatment episode (y of dollars not listed) |
| Zafar, 2013 (23) | 258 cancer survivors with breast, colorectal, lung, or other solid tumors | Multiple cities and states; HealthWell Foundation and Duke University Medical Center; 2010 to 2011 (up to 4 mo) | Cancer-related OOP expenses | Median monthly OOP of $456, including $28 in travel, $15 in nonprescription medication, $120 in insurance premium, $56 in prescription medication (2011 US dollars) |
*Study evaluated three novel target agents: the proteasome inhibitor bortezomib and the immunomodulatory agents thalidomide and its analog lenalidomide. BCEI = Breast Cancer Education Intervention clinical trials; BOR = bortezomib; CCAE = Commercial Claims and Encounters; LEN = lenalidomide; MCBS = Medicare Current Beneficiary Survey; MEPS = Medical Expenditures Panel Survey; NHIS = National Health Interview Survey; OOP = out of pocket; SEER = Surveillance, Epidemiology and End Results program; THAL = thalidomide.