OOP Expenses Research Articles

Impact of family doctor system on diabetic patients with distinct service utilisation patterns: a difference-in-differences analysis based on group-based trajectory modelling

IntroductionThis study examines the impact of China’s family doctor system (FDS) on healthcare utilisation and costs among diabetic patients with distinct long-term service utilisation patterns.MethodsConducted in City A, eastern China,...

Abstract 4825: Addressing financial toxicity in cancer clinical trial participation: Barriers and facilitators of enrolling in a reimbursement program for out-of-pocket travel costs

Abstract Financial toxicity has been associated with adverse outcomes for patients with cancer. Out-of-pocket (OOP) costs contribute to the high financial toxicity (FT) experienced by patients with cancer. Cancer clinical trial (CCT) participants face significant extra OOP expenses presenting a barrier to participation and retention. To address FT in CCTs, the Lazarex Foundation created the Improving Patient Access to Cancer Clinical Trials (IMPACT) Program, a financial reimbursement program (FRP) for OOP travel and lodging costs associated with therapeutic CCT participation. Our study aimed to quantify the FT experienced by patients in CCTs and understand their experience to determine the barriers and facilitators of enrolling in the Lazarex IMPACT Program. Patients enrolled in a CCT were referred to the IMPACT team to determine eligibility. Patients were eligible for IMPACT if they were active on a therapeutic CCT and their household income was less than 700% of the most recent HHS federal poverty guidelines. Patients who enrolled in the program were invited to participate in a brief semi-structured interview via telephone call. We used grounded theory techniques of analysis to identify themes of barriers and facilitators to enrollment in the Lazarex IMPACT program at our cancer center. Table 1 shows the emerging themes from the interviews as barriers and facilitators of enrolling in IMPACT. As a part of the interview process, patients also completed the COST-FACIT questionnaire, a patent reported outcomes measure to evaluate the degree of FT associated with cancer. COST scores in our cohort (n=39) ranged from 14-39.6, mean=27.12, median=27.5; SD=7.96. Following enrollment in the program, patients on average had COST scores indicating low degrees of financial distress. Taken altogether, our results have the potential to inform the development of FRPs for patients with cancer to facilitate their participation in CCTs. Table 1. Emerging themes from grounded analysis of semi-structured interviews and their frequency Barrier to enrolling in FRP program. No. of Participants Facilitator of enrolling in FRP program No. of Participants Patients wanted to be made aware of program earlier in their CCT timeline 4 Enrollment process was easy and straightforward 17 Patients made aware of program after their CCT started 3 IMPACT team contacted patients to offer program 13 CCT Team unaware of program availability 3 Patients learned about the program through their CCT team 8 Patients reported difficulty with technology access and literacy 3 Patients reported sufficient technology access and literacy 4 Patients reported hesitancy sharing financial information 2 Cancer foundation was timely and helpful in enrollment process 2 Patients reported difficulty navigating vast resources at cancer center 1 Cancer Center social workers provided connection to program 1 Citation Format: Elizabeth Ramos, Vivian Nguyen, Ashley Santaniello, Dana Dornsife, Robert G. Johnson, Paul E. Wileyto, Robert H. Vonderheide, Carmen E. Guerra. Addressing financial toxicity in cancer clinical trial participation: Barriers and facilitators of enrolling in a reimbursement program for out-of-pocket travel costs [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4825.

Health Benefit Utilization and Out-of-Pocket Expenses in Outpatient Care and Hospitalizations: Baseline Surveys of Three Primary Care Sites in the Philippines.

The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country. The objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings. Cross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses. A total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site.For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita). Compared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of "equal" benefits can inadvertently lead to "inequitable" healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.

THE IMPACT OF CLOSING MEDICARE PART D COVERAGE GAP ON MENTAL HEALTH OF OLDER ADULTS

Abstract The ACA mandated the gradual elimination of the Medicare prescription drug coverage gap (also called the “Doughnut Hole”) beginning in 2011. This policy change can impact mental health through mechanisms such as reduction in out-of-pocket (OOP) expenses and increased access to prescription medication. However, no previous study has examined its impact on mental health outcomes of older adults on Medicare. Employing data from the Medical Expenditure Panel Survey (from 2006 to 2016), compare the mental health of Medicare beneficiaries (66-70 years; N=7,664) with that of non-Medicare beneficiaries (60-64 years; N=8,079) before versus after policy implementation. We find that the 2011 phasing out of Medicare drug coverage gap was associated with 0.86-point (p< 0.05) improvement in the Mental Component score of the Short-Form 12 Health Survey among beneficiaries. Our analysis was robust to using alternate measures of mental health outcomes (Kessler Index and PHQ-2) as well as to an alternate construction of treatment and control groups (comparing individuals aged 60-70 years on Medicare and private insurance). We find no detectable differences in the mental health of Medicare beneficiaries who already receive subsidies for costs associated with the coverage gap through the Low Income Subsidy (LIS) program. Further, we find that elimination of the doughnut hole reduced OOP expenses by $32.65 among Medicare beneficiaries in our sample. Overall, our results for mental health and OOP expenses are mainly attributable to women. This evidence highlights indirect effects of drug coverage gap elimination on mental health outcomes among Medicare beneficiaries.

Community pharmacists’ views about prescription medicine co-payments and potential implications for equitable access to medicines: a critical realist interpretation

BackgroundIn many countries the community pharmacist’s role includes collecting prescription medicine co-payments at the point of dispensing. This is a context which can provide unique insights into individuals’ access to prescription medicines, as interactions with service users about out-of-pocket (OOP) expenses that may negatively affect a pharmacist’s patient counselling role. Prior research has identified that OOP expenses for prescription medicines led to decreased treatment adherence. This study aims to understand the role of community pharmacists in the collection of co-payments for prescription medicines in one region of Aotearoa New Zealand, and the possible implications for equitable access to medicines.MethodsThis is a qualitative study using a case study research design. Data were collected through focus groups, individual interviews, and an electronic survey. Using a critical realist approach in thematic analysis, findings were categorised as Causal tendencies (the things that cause the events); Events (the things that community pharmacists experience); and Experiences (the perceptions and feelings of individual participants).ResultsOur analysis finds that the current profession of community pharmacy in Aotearoa New Zealand, is under strain. The results suggest that broader government policies, such as the pharmacist’s role in delivering essential health services, the fairness of standard prescription co-payments, and the role of community pharmacists as gatekeepers, have a significant influence on the profession. In addition, the study found that individual community pharmacists have a unique position in the co-payment process, face power imbalances within their role, and the study indicates evidence of value judgements towards service users.ConclusionsThis study is exploratory; however, its examination of the policy of prescription medicine co-payments from the perspective of community pharmacists, who play a vital role in both dispensing medicines and collecting prescription medicine co-payments, is novel. Despite prescription medicine co-payments being a routine part of pharmacists’ role in many countries, it is a topic where there is limited published peer-reviewed literature. The study adds to existing evidence that funding models influence community pharmacists’ role. In addition, this study identified value judgements about service users in relation to prescription medicine co-payments which may influence service users’ health-seeking behaviour. In this setting, limited representation of at-risk populations in the community pharmacy profession may be a factor that negatively influence interactions between pharmacists and service users.

Patient-reported outcomes and financial toxicity in head and neck cancer (PaRTNer): Longitudinal assessment of financial toxicity and associated quality of life from a pilot study.

23 Background: Patients undergoing definitive radiation therapy (RT) for head and neck cancer (HNC) are at risk for financial toxicity given complex treatment and high symptom burden. The PaRTNer study was designed to longitudinally assess out-of-pocket (OOP) expenses, financial toxicity (FT), and quality of life (QOL). Methods: Single-institution, prospective longitudinal study (NCT3506451) of adult patients with non-metastatic HNC undergoing definitive RT. Surveys at baseline, 3 mo, and 6 mo post-RT collected validated QOL and FT measures (FACT-HN and COST-FACIT [COST score <26 indicating FT]) and OOP expenses. Retrospective chart review documented social work (SW) and financial care counselor (FCC) interactions. Paired t-tests, Wilcoxon Rank Sum tests, ANOVA, and Spearman correlation estimates were used to assess associations in outcomes. Results: 60 patients were enrolled from 2019-2021, with 80% completing all 3 surveys. Most were white (76%), male (68%), and non-Hispanic (98%). Median age was 61 (range 42-86). Most were married or in long-term partnerships (69%), had completed at least some college (71%), and had employer-sponsored private insurance (55%). About half were working at least part-time, and most earned >$60k/yr (55%); median annual income was $88k (Range: $6k-800k). Median COST scores at baseline, 3 mo, and 6 mo post-RT were 25, 30, and 32, respectively (p<0.001, baseline vs 6 mo). Median cumulative OOP expense was $6,909 (Range: $0-43,572). Cumulative OOP expense had a weakly positive correlation with income (r=0.39, p=0.024), but did not significantly correlate with COST scores. 33% were referred to SW; these patients had lower mean COST scores at baseline compared to patients not referred to SW (16 vs 28, p=0.0007). 38% were referred to FCC, with no significant difference in baseline COST scores (20 vs 26, p=0.07). Median FACT-HN score decreased from baseline to 3 mo (117 to 110, p=0.03) and increased from 3 to 6 mo (110 to 115.5, p=0.0007); there was no difference between baseline and 6 mo post-RT. Those with lower COST scores had lower median FACT-HN scores at all 3 time points (108 vs 124, p=0.001; 99 vs 107, p=0.006; 100 vs 122, p=0.0006 at baseline, 3 mo, and 6 mo respectively). There was a positive correlation between baseline OOP expense and FACT-HN score (r=0.497, p=0.0002), which did not persist at 3 or 6 mo post-RT. Conclusions: This small longitudinal study found that patients undergoing definitive RT for HNC experienced FT at baseline; however, this improved post-RT. Patients paid several thousand dollars OOP over the course of RT and recovery, but OOP expenses did not appear to drive worse FT or QOL. Designing patient-facing interventions including facilitated referral to SW or FCC could help those with significant FT, but defining the optimal population and intervention time point requires further study. Clinical trial information: NCT3506451 .

An Effective Health Care System through Health Technology Assessment and Evidence Based Payment System in India

The purpose of this research is to discuss the significance of health care insurance compensation for obtaining comprehensive medical treatment in India. Through a systematic review survey focusing on the keywords like out-of-pocket, Health Technology Assessment and Health care system was conducted by using the searches from Google Scholar, Science Direct, PubMed and ProQuest Database, it is observed that India ranks among the greatest out-of-pocket (OOP) healthcare expenditures in the globe. This seems to be notwithstanding the deployment of several public health plans and the provision of a significant variety of both private and public health coverage schemes. Decrease in the treatment quality across many healthcare institutions of government is a key cause causing the typical Indian individual to constantly rely on medical services provided by private firms, heading up OOP expenses. Among the most significant problems in implementing universal health care (UHC) in India is a poor acceptance of insurance products and awareness between many Indians. The burden of large OOP expenditures on people might be lessened by increasing medical insurance acceptance, which may be accomplished by enhancing India's medical claims system.

Patient perceptions of copay card utilization and policies

ABSTRACT Background: Copay cards are intended to mitigate patient out-of-pocket (OOP) expenses. This qualitative, exploratory focus group study aimed to capture patient perceptions of copay cards and copay adjustment programs (CAPs; insurers’ accumulator and maximizer policies), which redirect the copay card utilization benefits intended for patients’ OOP expenses. Methods: Patients with chronic conditions were recruited through Janssen’s Patient Engagement Research Council program. They completed a survey and attended a live virtual session to provide feedback on copay cards. Results: Among 33 participants (median age, 49 years [range, 24–78]), the most frequent conditions were cardiovascular-metabolic disease and inflammatory bowel disease. Patients associated copay cards with lessening financial burden, improving general and mental health, and enabling medication adherence. An impact on medication adherence was identified by 10 (63%) White and nine (100%) Black respondents. Some patients were unaware of CAPs despite having encountered them; they recommended greater copay card education and transparency about CAPs. Conclusion: Patients relied on copay cards to help afford their prescribed medication OOP expenses and maintain medication adherence. Use of CAPs may increase patient OOP expenses. Patients would benefit from awareness programs and industry – healthcare provider partnerships that facilitate and ensure access to copay cards.

44 Higher Out-of-pocket Expenses are Associated with Worse Health-Related Quality of Life in Burn Survivors

Abstract Introduction The care required to recover serious burn injuries is costly. In the US, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Methods Financial data from a regional burn center were merged with data in the Burn Model System (BMS) National Database. HRQL outcomes included VA-Rand 12 (VR-12) physical component summary (PCS) and mental component summary (MCS) scores. Participant surveys were conducted at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, sex, insurance/payer, self-identified race/ethnicity, measures of burn injury severity). Results 644 participants were included, of which 13% (84) had OOP costs. The percentage of participants with OOP costs was 34% for commercial/private, 22% for Medicare, 8% for other, 4% for self-pay, and 0% for workers’ compensation and Medicaid. For participants with OOP expenses, median payments were $875 with an IQR of $368 - 1,728. In addition to markers of burn injury severity, OOP costs were negatively associated with PCS scores at 6-months (coefficient -0.002, p< 0.001) and 12-months post-injury (coefficient -0.001, p=0.004). There were no significant associations with PCS scores at 24 months post-injury or MCS scores at any interval. Conclusions Participants with commercial/private or Medicare payer had higher financial liability than other payers. Higher OOP expenses were negatively associated with physical HRQL for at least 12 months after injury. Applicability of Research to Practice Financial toxicity is a real phenomenon in burn survivors. Burn care providers should be attuned to their patients' finances and spending and connect them with resources when appropriate.

Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City.

This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.

Impacts of unifying urban and rural residents’ medical insurance on the hospitalisation expenses of rural patients in eastern China: an interrupted time series analysis

ObjectivesThis study evaluated the impact of the Urban and Rural Residents’ Basic Medical Insurance scheme on hospitalisation expenses of rural patients in eastern China, which unified separate healthcare systems for...

Does reducing out-of-pocket costs for children’s surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study

ObjectivesAn estimated 1.7 billion children around the world do not have access to safe, affordable and timely surgical care, with the financing through out-of-pocket (OOP) expenses being one of the...

Higher Out-of-pocket Expenses are Associated with Worse Health-related Quality of Life in Burn Survivors: A Northwest Regional Burn Model System Investigation.

The care required to recover serious burn injuries is costly. In the United States, these costs are often borne by patients. Examining the relationship between out-of-pocket (OOP) costs and health-related quality of life (HRQL) is important to support burn survivors. Financial data from a regional burn center were merged with data in the Burn Model System (BMS) National Database. HRQL outcomes included VA-Rand 12 (VR-12) physical component summary (PCS) and mental component summary (MCS) scores. Participant surveys were conducted at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, sex, insurance/payer, self-identified race/ethnicity, measures of burn injury severity). 644 participants were included, of which 13% (84) had OOP costs. The percentage of participants with OOP costs was 34% for commercial/private, 22% for Medicare, 8% for other, 4% for self-pay, and 0% for workers' compensation and Medicaid. For participants with OOP expenses, median payments were $875 with an IQR of $368-1728. In addition to markers of burn injury severity, OOP costs were negatively associated with PCS scores at 6-months (coefficient -0.002, P < .001) and 12-months post-injury (coefficient -0.001, P = .004). There were no significant associations with PCS scores at 24 months post-injury or MCS scores at any interval. Participants with commercial/private or Medicare payer had higher financial liability than other payers. Higher OOP expenses were negatively associated with physical HRQL for at least 12 months after injury. Financial toxicity occurs after burn injury and providers should target resources accordingly.

The Direct and Indirect Costs of Cancer among the Lower-Income Group: Estimates from a Pilot and Feasibility Study.

Healthcare in Malaysia is largely publicly funded, however, cancer could still result in out-of-pocket (OOP) expenses, which may burden the affected patients. This is especially relevant to those in the lower-income group. This pilot study was conducted to estimate the direct and indirect costs of cancer and evaluate the feasibility of obtaining these costs information from the lower-income cancer patients undergoing treatment. A cross-sectional study of patients with cancer was conducted in Hospital Kuala Lumpur between September and October 2020. Self-reported data from the patients were collected using face-to-face interviews. Detailed information about cancer-related OOP expenses including direct medical, direct non-medical, and productivity loss in addition to financial coping strategies were collected. Costs data were estimated and reported as average annual total costs per patient. The mean total cost of cancer was estimated at MYR 7955.39 (US$ 1893.46) per patient per year. The direct non-medical cost was the largest contributor to the annual cost, accounting for 46.1% of the total cost. This was followed by indirect costs and direct medical costs at 36.0% and 17.9% of the total annual costs, respectively. Supplemental food and transportation costs were the major contributors to the total non-medical costs. The most frequently used financial coping strategies were savings and financial support received from relatives and friends. This study showed that estimation of the total cost of cancer from the patient's perspective is feasible. Considering the significant impact of direct non-medical and indirect costs on the total costs, it is vital to conduct further exploration of its cost drivers and variations using a larger sample size.

Medical insurance payment schemes and patient medical expenses: a cross-sectional study of lung cancer patients in urban China

BackgroundAs the main cause of cancer death, lung cancer imposes seriously health and economic burdens on individuals, families, and the health system. In China, there is no national study analyzing the hospitalization expenditures of different payment methods by lung cancer inpatients. Based on the 2010–2016 database of insured urban resident lung cancer inpatients from the China Medical Insurance Research Association (CHIRA), this paper aims to investigate the characteristics and cost of hospitalized lung cancer patient, to examine the differences in hospital expenses and patient out-of-pocket (OOP) expenses under four medical insurance payment methods: fee-for-service (FFS), per-diem payments, capitation payments (CAP) and case-based payments, and to explore the medical insurance payment method that can be conducive to controlling the cost of lung cancer.MethodThis is a 2010–2016, 7-year cross-sectional study. CHIRA data are not available to researchers after 2016. The Medical Insurance Database of CHIRA was screened using the international disease classification system to yield 28,200 inpatients diagnosed with lung cancer (ICD-10: C34, C34.0, C34.1, C34.2, C34.3, C34.8, C34.9). The study includes descriptive analysis and regression analysis based on generalized linear models (GLM).ResultsThe average patient age was 63.4 years and the average length of hospital stay (ALOS) was 14.2 day; 60.7% of patients were from tertiary hospitals; and 45% were insured by FFS. The per-diem payment had the lowest hospital expenses (RMB7496.00/US$1176.87), while CAP had the lowest OOP expenses (RMB1328.18/US$208.52). Compared with FFS hospital expenses, per-diem was 21.3% lower (95% CI = -0.265, -0.215) and case-based payment was 8.4% lower (95% CI = -0.151, -0.024). Compared with the FFS, OOP expenses, per-diem payments were 9.2% lower (95% CI = -0.130, -0.063) and CAP was 15.1% lower (95% CI = -0.151, -0.024).ConclusionFor lung cancer patients, per-diem payment generated the lowest hospital expenses, while CAP meant patients bore the lowest OOP costs. Policy makers are suggested to give priority to case-based payments to achieve a tripartite balance among medical insurers, hospitals, and insured members. We also recommend future studies comparing the disparities of various diseases for the cause of different medical insurance schemes.

Atopic Dermatitis Polypharmacy and Out-Of-Pocket Healthcare Expenses.

Atopic dermatitis (AD) out-of-pocket (OOP) expenses are substantial and impact household finances. Prescription polypharmacy and its association with OOP expenses in AD is poorly understood. To characterize prescription polypharmacy and its association with OOP healthcare expenses among individuals with AD. An online survey was administered to National Eczema Association members (N=113,502). Inclusion criteria (US resident, age &ge;18, self-reported or caregiver of individual with AD) was met by 77.3% (1,118/1,447) of respondents. Polypharmacy (&ge;5 prescription treatments for AD in the past year) was associated with increased AD severity, poorer control, increased flares, increased healthcare provider visits, and comorbid asthma, allergic rhinitis, food allergy, and skin infections (P&le;0.01). Polypharmacy noted with all prescription therapies was most associated with biologic (dupilumab), oral immunosuppressant (azathioprine, cyclosporine, methotrexate, corticosteroids), oral antimicrobial, and topical calcineurin inhibitor (P&le;0.0005) use. Respondents with polypharmacy had increased OOP expenditures across numerous categories, including office visit co-pays, prescription medications both covered and not covered by insurance, hospitalization, emergency room visits, mental health services, non-prescription health products such as sleep aids, analgesics, and supplements, and alternative medications (P&lt;0.005). Individuals with polypharmacy had elevated yearly OOP expenses (median [range]: $1200 [$0-$200,000]), higher monthly OOP costs than average, and more harmful household financial impact (P&lt;0.0001 for all). Individuals with AD report considerable polypharmacy, which is associated with increased OOP expenses and harmful financial impact. Strategies are needed to reduce polypharmacy, minimize OOP costs, and optimize clinical outcomes. J Drugs Dermatol. 2023;22(2): doi:10.36849/JDD.7038.

Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study

ObjectiveWe aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.DesignProspective cohort studySettingEmergency department (ED) of a tertiary-level hospital...

Out-of-pocket costs sustained in the last 12months by cancer patients: an Italian survey-based study on individual expenses between 2017 and 2018.

Out of Pocket costs (OOP) sustained by cancer patients also in public NHS contribute to disease-related financial toxicity. Aim of the study was to investigate the amount and the types of OOP sustained by Italian cancer patients for care services. A sample survey was conducted by FAVO in December 2017-June 2018, in 39 adhering hospitals and 1289 patients diagnosed from 1985 to 2018, by standardized questionnaire inquiring on: yearly expenditure by cancer service, age, year of diagnosis, disease phase, cancer site, sex, marital status, education, residence. Univariate and multivariableregression analyses were performed between OOP and each variable. Multilevel mixed-effects negative binomial regression was used to assess the combined effects of patients characteristics on the differences in acquiring health services. The yearly average OOP was 1841.81€, with the highest values for transports (359.34€) and for diagnostic examinations (259.82€). Significantly higher OOP were found in North and Centre than South and Islands (167.51 vs. 138.39). In the fully adjusted multivariable analysis, the variables significantly associated with higher than reference expenditure were: medium/high education (OR 1.22 [1.05-1.42], upper gastrointestinal tract cancer (OR 1.37 [1.06-1.77]), disease phase of treatments for cancer progression or pain therapy (OR 1.59 [1.30-1.93]). Italian cancer patients in 2018 sustained OOP quite similar to those measured in 2012 to supplement NHS services. The main component of the OOP costs were diagnostic examination and transportation. The NHS should pay attention to potentiate its ability to answer unmet needs of patients with advanced cancer who are the most fragile ones. Reinforcing the services where the main OOP expenses are located can help in promoting public health actions and reduce socio-economic needs that could compromise the receipt of optimal care along the whole disease course, from diagnosis to rehabilitation.

The financial burden of out-of-pocket healthcare expenses on caregivers of children with atopic dermatitis in the United States.

Atopic dermatitis (AD) is associated with elevated financial costs, including out-of-pocket (OOP) expenses. Yet, the full burden of OOP expenses in children with AD is poorly understood. We sought to characterise categories, impact, and associations of caregiver-reported OOP AD healthcare expenses for US children. An online survey was administered to National Eczema Association members (N=113502). Inclusion criteria (US resident; respondent age ≥18; self or caregiver report of AD diagnosis) was met by 77.3% (1118/1447) of those who completed the questionnaire. Caregivers of children (<18years) with AD reported increased healthcare provider (HCP) visits, comorbid food allergy, cutaneous infections, and topical antimicrobial use (p<0.005 for all), and increased OOP expenses for hospitalisation, emergency room visits, emollients, hygiene/bathing products, childcare, and specialised cleaning products, and clothing/bedding (p<0.05 for all) compared to adults with AD. Children with AD had increased median total yearly OOP expenditures ($860 vs. $500, p=0.002) and were more likely to spend ≥$1000 OOP per year (48.9% vs. 40.0%, p=0.03). In children, yearly OOP expenses ≥$1000 were associated with increased AD severity, flares, HCP visits, prescription polypharmacy, and step-up therapy use (p<0.005 for all) compared with adults. Predictors of harmful financial impact among children included black race (adjusted OR [95% confidence interval]: 3.86 [1.66-8.98] p=0.002) and ≥$1000 annual OOP expenditures (6.98 [3.46-14.08], p<0.0001). Children with AD have unique and increased OOP expenses that are associated with significant disease burden. Strategies are needed to reduce OOP costs and improve clinical outcomes in children with AD.

33843 Atopic dermatitis polypharmacy and out-of-pocket health care expenses in the United States

Background: Atopic dermatitis (AD) out-of-pocket (OOP) expenses are substantial and impact household finances. Prescription polypharmacy and its association with out-of-pocket (OOP) expenses in AD is poorly understood. Objective: To characterize prescription polypharmacy and its association with OOP health care expenses among individuals with AD. Methods: An online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (U.S. resident, age ≥18, self-reported or caregiver of individual with AD) was met by 77.3% (1118/1447) of respondents. Results: Polypharmacy (≥5 prescription treatments for AD in the past year) was associated with increased AD severity, poorer control, increased flares, increased healthcare provider visits (HCP), and comorbid asthma, allergic rhinitis, food allergy, and skin infections (P ≤ .01). Polypharmacy was also associated with biologic (dupilumab), oral immunosuppressant (azathioprine, cyclosporine, methotrexate, corticosteroids), oral antimicrobial, and topical calcineurin inhibitor use (P ≤ .0005). Respondents with polypharmacy had increased OOP expenditures across numerous categories including office visit co-pays, prescription medications both covered and not covered by insurance, hospitalization, emergency room visits, mental health services, non-prescription health products such as sleep aids, analgesics, and supplements, and alternative medications (P < .005). Individuals with polypharmacy had elevated yearly OOP expenses (median [range]: $1200 [$0-$200,000]), higher monthly OOP costs, and more harmful household financial impact (P < .0001 for all). Similar results were observed with a less stringent definition of polypharmacy (≥3 prescription treatments). Conclusion: Individuals with AD report considerable polypharmacy, which is associated with increased OOP expenses and significant financial impact. Strategies are needed to reduce polypharmacy, minimize OOP costs, and optimize clinical outcomes.