OOP Expenses Research Articles

345 The burden of atopic dermatitis out-of-pocket healthcare expenses in United States children

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 characterized categories, impact, and associations of OOP AD healthcare expenses in US children. An online survey was administered to National Eczema Association members (N=113,502). Inclusion criteria (US resident; respondent age ≥18; self or caregiver report of AD diagnosis) was met by 77.3% (1,118/1,447). Children (<18 yrs) vs.

Financial risk protection in health care in Bangladesh in the era of Universal Health Coverage

BackgroundEnsuring financial risk protection in health care and achieving universal health coverage (UHC) by 2030 is one of the crucial Sustainable Development Goals (SDGs) targets for many low- and middle-income countries (LMICs), including Bangladesh. We examined the critical trajectory of financial risk protection against out-of-pocket (OOP) health expenditure in Bangladesh.MethodsUsing Bangladesh Household Income and Expenditure Survey data from 2005, 2010, and 2016, we examined the levels and distributions of catastrophic health expenditure (CHE) and impoverishment incidences. We used the normative food, housing, and utilities method, refining it by categorizing households with zero OOP expenses by reasons.ResultsOOP expenditure doubled between 2005 and 2016 (USD 115.6 in 2005, USD 162.1 in 2010, USD 242.9 in 2016), accompanied by rising CHE (11.5% in 2005, 11.9% in 2010, 16.6% in 2016) and impoverishment incidence (1.5% in 2005, 1.6% in 2010, 2.3% in 2016). While further impoverishment of the poor households due to OOP expenditure (3.6% in 2005, 4.1% in 2010, 3.9% in 2016) was a more severe problem than impoverishment of the non-poor, around 5.5% of non-poor households were always at risk of impoverishment. The poorest households were the least financially protected throughout the study period (lowest vs. highest quintile CHE: 29.5% vs. 7.6%, 33.2% vs. 7.2%, and 37.6% vs. 13.0% in 2005, 2010, and 2016, respectively). The disparity in CHE among households with and without chronic illness was also remarkable in 2016 (25.0% vs. 9.1%).ConclusionFinancial risk protection in Bangladesh exhibits a deteriorated trajectory from 2005 to 2016, posing a significant challenge to achieving UHC and, thus, the SDGs by 2030. The poorest and chronically ill households disproportionately lacked financial protection. Reversing the worsening trends of CHE and impoverishment and addressing the inequities in their distributions calls for implementing UHC and thus providing financial protection against illness.

898-P: Impact of Switching to a High-Deductible Health Plan on Patients’ Out-of-Pocket Expenditures for Glucose-Lowering Drugs

High deductible health plans (HDHPs) have become increasingly common as a means of increasing access to health insurance while curbing total utilization. However, high out-of-pocket (OOP) expenditures faced by HDHP enrollees may disincentivize high value care, particularly for people with chronic but costly health conditions like diabetes. Glucose-lowering drugs are a large part of direct costs of diabetes management and contribute to cost-related non-adherence, burden of treatment, and poor health outcomes. We examined the changes in OOP expenses for a 30-day supply of each class of glucose-lowering drugs among 43,900 adults with diabetes included in OptumLabs® Data Warehouse between 20 and 2018 who switched from non-HDHPs to HDHPs, compared to 333,803 adults who did not switch. The mean OOP expenses, standardized to 20$US, were higher for HDHP beneficiaries (Table) . Switching to a HDHP significantly increased OOP expenditures for all glucose-lowering classes, ranging from 5% increase (sulfonylurea) to 48% increase (glitazone) . This increased expense for patients may hinder adherence and adversely impact glycemic management and health outcomes among HDHP enrollees. Clinicians should be aware that HDHP enrollees may be more sensitive to OOP costs when choosing medications, and policy makers should exempt evidence-based prescription drugs from high deductibles. Disclosure D.H.Jiang: None. J.Herrin: Consultant; Johnson &amp; Johnson Medical Devices Companies. H.Van houten: None. R.G.Mccoy: Consultant; Emmi. Funding National Institute of Diabetes and Digestive and Kidney Diseases grant number K23DK114497

The Economic Burden of Hospital Costs on Families With Type 1 Diabetes Mellitus Children: The Role of Medical Insurance in Shandong Province, China.

ObjectiveThis study estimates the economic burden imposed on families by comparing the hospitalization costs of T1DM children with and without medical insurance in Shandong province.MethodsOur data comprised 1,348 T1DM inpatient records of patients aged 18 years or younger from the hospitalization information system of 297 general hospitals in 6 urban districts of Shandong Province. Descriptive statistics are presented and regression analyses were conducted to explore the factors associated with hospitalization costs.ResultsChildren with medical insurance had on average total hospitalization expenditures of RMB5,833.48 (US$824.02) and a hospitalization stay of 7.49 days, compared with the children without medical insurance who had lower hospitalization expenditures of RMB4,021.45 (US$568.06) and an average stay of 6.05 days. Out-of-pocket expenses for insured children were RMB3,036.22 (US$428.89), which is significantly lower than that of the uninsured children (P < 0.01). Out-of-pocket (OOP) expenditures accounted for 6% of the annual household income of insured middle-income families, but rose to a significant 25% of the annual income for low-income families. These OOP expenditures imposed a heavy economic burden on families, with some families experiencing long-term financial distress. Both insured and uninsured families, especially low-income families, could be tipped into poverty by hospitalization costs.ConclusionHospitalization costs imposed a significant economic burden on families with children with T1DM, especially low-income insured and uninsured families. The significantly higher hospitalization expenses of insured T1DM children, such as longer hospitalization stays, more expensive treatments and more drugs, may reflect both excess treatment demands by parents and over-servicing by hospitals; lower OOP expenses for uninsured children may reflect uninsured children from low-income families forgoing appropriate medical treatment. Hospital insurance reform is recommended.

Managing Urban Stroke Health Expenditures in China: Role of Payment Method and Hospital Level.

Stroke is one of the leading public health issues in China and imposes a heavy financial burden on patients and the healthcare system. This study assess which payment method provides the lowest hospital costs for China's healthcare system and the lowest out-of-pocket (OOP) expense for insured patients. This is a 4-year cross-sectional study. From the China Health Insurance Research Association (CHIRA) database, a 5% random sample of urban health insurance claims was obtained. Descriptive analysis was conducted and a generalized linear model (GLM) with a gamma distribution and a log link was estimated. For outpatients, capitation payment had the lowest hospital cost (RMB180.9/US$28.8) and lowest OOP expenses (RMB75.6/US$12.0) per patient visit in primary hospitals compared with fee-for-service (FFS) payments. The global budget (GB) displayed the lowest total hospital costs (RMB344.7/US$54.8) in secondary hospitals, and was 27.4% (95% CI=-0.32, -0.29) lower than FFS. FFS had the lowest OOP expenses (RMB123.4/US$19.6 vs. RMB151.8/US$24.1) in secondary and tertiary hospitals. For inpatients, FFS had the lowest total hospital costs (RMB5918.7/US$941.1) per visit and capitation payments had the lowest OOP expenses (RMB876.5/US$139.4, 40.1% lower than FFS, 95% CI=-0.58, -0.15) in primary hospitals. Capitation payment had both the lowest hospital costs (RMB7342.9/US$1167.5 vs. RMB17 711.7/US$2816.2) and the lowest OOP expenses (RMB1664.2/US$264.6 vs. RMB3276.3/US$520.9) for both secondary and tertiary hospitals. For outpatients in primary hospitals and inpatients in secondary and tertiary hospitals, the capitation payment was the most money-saving payment method delivering both the lowest OOP expenses for patients and the lowest hospital total costs for hospitals. We recommend that health policymakers prioritize the implementation of the payment method with the lowest OOP expenses when the payment method does not deliver both the lowest hospital costs for the health system and lowest OOP expenses for patients.

Effect of Out-of-Pocket Costs on Subsequent Mammography Screening.

Although the Affordable Care Act eliminated cost sharing for screening mammography, a concern is that grandfathered plans, diagnostic mammograms, and follow-up testing may still lead to out-of-pocket (OOP) spending. Our study examines how OOP spending among women at their baseline screening mammogram may impact the decision to receive subsequent screening. The study included commercially insured women aged 40 to 41 years with a screening mammogram between 2011 and 2014. We estimated multivariate linear probability models of the effect of OOP spending at the baseline mammogram on subsequent screening 12 to 36 months later. Having any OOP payments for the baseline screening mammogram significantly reduced the probability of screening in the subsequent 12 to 24 months by 3.0 percentage points (pp) (95% confidence interval [CI]: 1.1-4.8 pp decrease). For every $100 increase in the OOP expenses for the baseline mammogram, the likelihood of subsequent screening within 12 to 24 months decreased by 1.9 pp (95% CI: 0.8-3.1 pp decrease). Similarly, any OOP spending for follow-up tests resulting from the baseline screening led to a 2.7 pp lower probability of screening 12 to 24 months later (95% CI: 0.9-4.1 pp decrease). Higher OOP expenses were associated with significantly lower screening 24 to 36 months later (coefficient=-0.014, 95% CI:-0.025 to-0.003). Although cost sharing has been eliminated for screening mammograms, OOP costs may still arise, particularly for diagnostic and follow-up testing services, both of which may reduce rates of subsequent screening. For preventive services, reducing or eliminating cost sharing through policy and legislation may be important to ensuring continued adherence to screening guidelines.

Do patients with haematological malignancies suffer financial burden? A cross-sectional study of patients seeking care through a publicly funded healthcare system

BackgroundIt is increasingly appreciated that some patients with cancer will experience financial burden due to their disease but little is known specifically about patients with haematological malignancies. Therefore, this study aimed to measure financial toxicity experienced by patients with haematological malignancies in the context of a publicly funded health care system. MethodAll current patients diagnosed with leukaemia, lymphoma or multiple myeloma, from two major metropolitan health services in Melbourne, Australia were invited to complete a survey capturing; patient demographics, employment status, income sources, financial coping and insurances, OOP expenses and self-reported financial toxicity using a validated measure. ResultsOf the 240 people approached, 113 (47 %) participated and most had leukaemia (62 %). Forty-seven (42 %) participants experienced some degree of financial toxicity using the Comprehensive Score for financial toxicity (COST) instrument. On multivariate linear regression, older age (>65 years, p = 0.007), higher monthly income (>$8000, p = 0.008), not having and being forced into unemployment or early retirement (p < 0.001) remained significantly associated with less financial toxicity. ConclusionFinancial toxicity is present in Australian haematology patients and those at higher risk may be patients of working age, those without private health insurance and patients that have been forced to retire early or have become unemployed due to their diagnosis.

Health-related out-of-pocket expenses for children living with rare diseases - tuberous sclerosis and mitochondrial disorders: A prospective pilot study in Australian families.

We aimed to describe health-related out-of-pocket (OOP) expenses incurred by Australian families living with children with chronic and complex diseases. A prospective pilot study of OOP expenses in families with children with tuberous sclerosis (TS) or mitochondrial disorders (MD) in 2016-2017. An initial survey assessed the family's financial situation, child's health functioning and estimated previous 6 months' and lifetime OOP expenses. Thereafter, families completed a survey each month for 6 months, prospectively tracking OOP expenses. Initial surveys were completed by 13 families with 15 children; median age 7 years (range: 1-12); 5 with MD, 10 with TS. All families reported OOP expenses: 38% paid $2000 per annum, more than double the annual per-capita OOP costs reported for Australia by the Organisation for Economic Co-operation and Development. Eight families estimated $5000-$25 000 in OOP expenses over their child's lifetime and 62% of mothers reduced or stopped work due to caring responsibilities. Eleven families paid annual private health insurance premiums of $2000-$5122, but 72% said this was poor value-for-money. Prospective tracking by eight families (9 children) identified the median OOP expenditure was $863 (range $55-$1398) per family for 6months. OOP spending was associated with visits to allied health professionals, non-prescription medicines, special foods, supplements and disposable items. Eight families paid for 91 prescription medications over 6months. All families caring for children with TS or MD reported OOP expenses. A larger study is needed to explore the affordability of health care for children living with a broader range of chronic diseases.

Impact and Associations of Atopic Dermatitis Out-of-Pocket Health Care Expenses in the United States.

Atopic dermatitis (AD) is associated with substantial financial cost, including increased out-of-pocket (OOP) expenses. Associations and impact of OOP costs are poorly understood. The aim of the study was to characterize the impact and associations of OOP health care expenses for AD. A 25-question online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents aged ≥18 years; self-reported AD or primary caregiver of individual with AD) were met by 77.3% (1118 of 1447). Respondents with monthly OOP expenses greater than $200 were more likely to have increased AD severity, flares, health care provider visits, prescription polypharmacy, use of step-up therapy, frequent skin infections, and poorer disease control ( P < 0.005 for all). Respondents with OOP yearly expenditures greater than $1000 had similar associations and additionally increased rates of comorbid asthma, allergic rhinitis, and anxiety/depression ( P < 0.005 for all). A total of 64.6% (n = 624) reported harmful household financial impact of OOP expenses. Predictors of harmful impact included severe AD (adjusted odds ratio [95% confidence interval], 2.62 [1.11-6.19], P = 0.04), comorbid asthma (1.42 [1.07-1.87], P = 0.03), 5 health care provider visits or more in a year (2.80 [1.62-4.82], P = 0.0007), greater than $200 OOP monthly expenditures (2.16 [1.45-3.22], 0.0006), and $1000 annual OOP expenditures or more (4.56 [3.31-6.27], P < 0.0001). Out-of-pocket expenses for AD significantly impact household finances. Clinical interventions are needed to minimize OOP expenses while optimizing care outcomes.Capsule Summary:• Atopic dermatitis (AD) is associated with significant financial cost, including increased out-of-pocket (OOP) expenses, although the impact and associations of OOP health care expenses for AD management are not well understood.• The OOP health care expenses related to AD are associated with increased disease severity and health care utilization and significantly impact the household finances of patients and caregivers.• Health care providers should be mindful of the OOP financial burden related to AD management and engage in shared decision making to create a treatment plan that is practical and effective and minimizes household financial impact.

A novel, out-of-pocket, cost-effectiveness analysis comparing a frontline niraparib-for-all to a biomarker-based strategy in patients with advanced ovarian cancer

<h3>Objectives:</h3> Niraparib has been FDA approved as frontline maintenance therapy (FMT) for advanced-stage ovarian cancer regardless of biomarker status. A recently published preferences study demonstrated that, on average, ovarian cancer patients are willing to pay (WTP) $424 per month for an additional 6 months of progression-free survival (PFS) and $6 per month if the PFS benefit is only 2 months. The objective of this study is to determine whether a niraparib-for-all FMT approach is cost-effective compared to a biomarker-based strategy (BBS) from a patient out-of-pocket (OOP) cost perspective. <h3>Methods:</h3> A Markov-based decision model simulating the publicly available PRIMA trial results was used to evaluate the cost-effectiveness of two FMT strategies from a patient perspective: (1) niraparib for all (niraparib-for-all) and (2) BBS, defined as niraparib only for deleterious germline/somatic <i>BRCA</i> mutations and homologous recombination deficient (HRD)+ tumors. Monthly OOP drug costs were estimated for commercially insured beneficiaries with ovarian cancer using MarketScan (2014 - 2017) and for Medicare beneficiaries using Surveillance, Epidemiology, and End Results (SEER)-Medicare (2014-2016). The median OOP cost for any PARP inhibitor given during the time period were aggregated. OOP costs fortoxicities were incorporated into the model as emergency department copay costs. For comparison to previously reported patient WTP data, cost-effectiveness was reported as the incremental cost-effectiveness ratio (ICER) in U.S. dollars per quality-adjusted progression-free month (QA-PFM) gained between strategies. <h3>Results:</h3> The median monthly OOP cost of PARP maintenance was $43 for commercially insured beneficiaries and $694 for Medicare beneficiaries. In the model, niraparib-for-all was more costly ($638 versus $362 for commercial insurance; $5841 vs $1029 for Medicare) and more effective (11-month PFS vs 9.6-month PFS) than BBS. For patients with commercial insurance, niraparib-for-all had an ICER of $200/QA-PFM compared to BBS, and could be considered potentially cost-effective compared to a previously published patient WTP of $424/QA-PFM. For patients with Medicare, niraparib-for-all had an ICER of $3,213/QA-PFM compared to BBS and is not cost-effective. A monthly OOP cost of $90 or less wound render niraparib-for-all cost-effective based on the published WTP threshold. <h3>Conclusions:</h3> For patients with private insurance, accounting for only OOP costs and assuming a PFS benefit of approximately 6 months, niraparib-for-all could be considered cost-effective, falling within patients' WTP, with an ICER of $200/QA-PFM compared to BBS. However, for patients with Medicare, both strategies incur considerably higher OOP expenses, and niraparib-for-all cannot be considered cost-effective. These results highlight the stark differences in financial burden on patients depending on their insurance coverage. Future cost-effectiveness studies should incorporate patient OOP costs and willingness to pay so that relative financial burden can be used to facilitate treatment conversations.

Out-of-pocket and private pay in clinical genetic testing: A scoping review.

Full coverage of the cost of clinical genetic testing is not always available through public or private insurance programs, or a public healthcare system. Consequently, some patients may be faced with the decision of whether to finance testing out-of-pocket (OOP), meet OOP expenses required by their insurer, or not proceed with testing. A scoping review was conducted to identify literature associated with patient OOP and private pay in clinical genetic testing. Seven databases (EMBASE, MEDLINE, CINAHL, PsychINFO, PAIS, the Cochrane Database of Systematic Reviews, and the JBI Evidence-Based Practice database) were searched, resulting in 83 unique publications included in the review. The presented evidence includes a descriptive analysis, followed by a narrative account of the extracted data. Results were divided into four groups according to clinical indication: (1) hereditary breast and ovarian cancer, (2) other hereditary cancers, (3) prenatal testing, (4) other clinical indications. The majority of studies focused on hereditary cancer and prenatal genetic testing. Overall trends indicated that OOP costs have fallen and payer coverage has improved, but OOP expenses continue to present a barrier to patients who do not qualify for full coverage.

Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market.

BackgroundOur study estimated insurance payments and patient out-of-pocket (OOP) expenses associated with discarded weight-based intravenous antineoplastic drugs for privately insured US adult patients with cancer.MethodsWe identified patients who received weight-based antineoplastic drugs from a 2017 MarketScan health risk assessment (IBM Corp, Armonk, NY) linked to claims data. Using weight information in the health risk assessment, we derived the recommended dose and calculated the percentage of drugs discarded. We applied β-regression to determine factors associated with the discarded percentages. To compare patients with and without high-deductible plans, we employed a generalized linear model and a 2-part model to examine insurance payment and OOP expense, respectively. All statistical tests were 2-sided.ResultsOf 27 350 claims for 58 weight-based antineoplastic drugs from 1970 patients, the median discarded percentage was 9.8% (mean [SD] = 12.8% [10.5%]). Aside from drug and tumor type, statistically significantly higher discarded percentages were found for patients in the lowest weight group (5.5% [95% confidence interval = 4.7% to 6.4%]; P < .001; weight <150 lb [68.0 kg] vs ≥200 lb [90.7 kg]). Private payers spent $5090 per patient in 2017 on discarded weight-based antineoplastic drugs, and patients’ mean OOP expense on discarded drugs was $63. In total, 39.7% of patients had high-deductible plans. The adjusted mean OOP expense for discarded drugs was statistically significantly higher for those in high-deductible plans ($95 vs $47; P < .001).ConclusionsPrivate insurers incurred substantial financial burden from discarded weight-based antineoplastic drugs. Although the OOP expenses of discarded drugs were modest for most privately insured patients with cancer, approximately 5% spent more than $400 on the discarded drugs. Policies designed to reduce drug waste from single-dose, weight-based antineoplastic drugs should evaluate their financial consequences for payers and patients.

A Scoping Review of Behavioral Interventions Addressing Medical Financial Hardship.

Little information has been compiled across studies about existing interventions to mitigate issues of medical financial hardship, despite growing interest in health care delivery. The purpose of this qualitative systematic scoping review was to examine content and outcomes of interventions to address medical financial hardship. PRISMA guidelines were applied to present results using PubMed, Scopus, and CINAHL, published between January 1980 and August 2020. Additional studies were identified through reference lists of selected papers. Included studies focused on mitigating medical financial hardship from out-of-pocket (OOP) health care expenses as an intervention strategy with at least 1 evaluation component. Screening 2412 articles identified 339 articles for full-text review, 12 of which met inclusion criteria. Variation was found regarding targets and outcome measurement of intervention. Primary outcomes were in the following categories: financial outcomes (eg, OOP expenses), behavioral outcomes, psychosocial, health care utilization, and health status. No included studies reported significant reduction in OOP expenses, perceptions of financial burden/toxicity, or health status. However, changes were observed for behavioral outcomes (adherence to treatment, patient needs addressed), some psychosocial outcomes (mental health symptoms, perceived support, patient satisfaction), and care utilization such as routine health care. No patterns were observed in the achievement of outcomes across studies based on intensity of intervention. Few rigorous studies exist in this emerging field, and studies have not shown consistent positive effects. Future research should focus on conceptual clarity of the intervention, align outcome measurement and achieve consensus around outcomes, and employ rigorous study designs, measurement, and outcome follow-up.

Mobile Application to Identify Cancer Treatment-Related Financial Assistance: Results of a Randomized Controlled Trial.

PURPOSE:Insured patients with cancer face high treatment-related, out-of-pocket (OOP) costs and often cannot access financial assistance. We conducted a randomized, controlled trial of Bridge, a patient-facing app designed to identify eligible financial resources for patients. We hypothesized that patients using Bridge would experience greater OOP cost reduction than controls.METHODS:We enrolled patients with cancer who had OOP expenses from January 2018 to March 2019. We randomly assigned patients 1:1 to intervention (Bridge) versus control (financial assistance educational websites). Primary and secondary outcomes were self-reported OOP costs and subjective financial distress 3 months postenrollment. In post hoc analyses, we analyzed application for and receipt of financial assistance at 3 months postenrollment. We used chi-square, Mann-Whitney tests, and logistic regression to compare study arms.RESULTS:We enrolled 200 patients. The median age was 57 years (IQR, 47.0-63.0). Most patients had private insurance (71%), and the median household income was $62,000 in US dollars (USD) (IQR, $36,000-$100,000 [USD]). Substantial missing data precluded assessment of primary and secondary outcomes. In post hoc analyses, patients in the Bridge arm were more likely than controls to both apply for and receive financial assistance.CONCLUSION:We were unable to test our primary outcome because of excessive missing follow-up survey data. In exploratory post hoc analyses, patients who received a financial assistance app were more likely to apply for and receive financial assistance. Ultimately, our study highlights challenges faced in identifying measurable outcomes and retaining participants in a randomized, controlled trial of a mobile app to alleviate financial toxicity.

Impact of hierarchical hospital reform on patients with diabetes in China: a retrospective observational analysis

ObjectivesWe assess whether China’s diabetes pilot hierarchical diagnosis and treatment reforms shifted patient healthcare-seeking behaviour towards primary health institutions (PHIs) and away from secondary and tertiary hospitals. From the patients’...

Catastrophic Health Expenditure, Distress Financing and Impoverishment due to Out-of-Pocket Expenses for Healthcare among Patients with Chronic Liver Disease: A Cross-sectional Study among Hospitalized Patients in Bangladesh

Out-of-pocket (OOP) expenses for hospitalized patients with chronic liver disease (CLD) poses an economic challenge on affected household in the form of catastrophic health expenditure (CHE), distress financing and impoverishment. OOP Expenses data for hospitalized CLD patients from Bangladesh is scarce. This study aimed to estimate the OOP expenses and resulting CHE, distress financing and impoverishment among hospitalized patients with CLD. This cross-sectional study was conducted among conveniently selected 107 diagnosed CLD patients admitted at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) aged 18 years and above. Data were collected from the respondents using a semi-structured questionnaire through face to face interview during discharge from hospital. Out of pocket expenditure for chronic liver disease in selected hospitals was Bangladeshi Taka (BDT) 19,262. Direct medical, direct non-medical and indirect cost was BDT 16,240; 2,165 and 1,510, respectively. Investigation cost and medicine cost contributed to 48.48% and 31.81% of the total OOP expenses, respectively. At 10% threshold level, 29% of the respondents were affected by CHE. 64.5% of the respondents were facing distress financing due to OOP expenses. Among the respondents, 1.9% slipped below the international poverty line of $1.90 (BDT 161.10, in 2019).There was statistically significant (p &lt; 0.05) difference among the mean OOP expenses for different etiological types of chronic liver disease. The study concluded that it requires establishing a more accessible and affordable decentralized health care system for CLD treatment along with the implementation of financial risk protection.

Longitudinal Trends of Financial Toxicity in Patients With Lung Cancer: A Prospective Cohort Study.

Cancer therapy is associated with severe financial burden. However, the magnitude and longitudinal patient relationship with financial toxicity (FT) in the initial course of therapy is unclear. Patients with stage II-IV lung cancer were recruited in a prospective longitudinal study between July 2018 and March 2020. FT was measured via the validated COmprehensive Score for financial Toxicity (COST) at the time of cancer diagnosis and at 6-month follow-up (6MFU). 6MFU data were compared with corresponding baseline data. A lower COST score indicates increased financial hardship. At the time of analysis, 215 agreed to participate. Subsequently, 112 patients completed 6MFU. On average, slightly more FT was observed at diagnosis compared with 6MFU (median COSTbase 25 v COST6M 27; P < .001); however, individual patients experienced large changes in FT. At 6MFU, 27.7% of patients had made financial sacrifices to pay for treatment but only 4.5% refused medical care based on cost. Median reported out-of-pocket (OOP) costs for the initial 6 months of cancer treatment was $2,496 (range, $0-25,900). Risk factors for FT at diagnosis were unique from risk factors at 6MFU. Actual OOP expenses were not correlated with FT; however, inability to predict upcoming treatment expenses resulted in higher FT at 6MFU. FT is a pervasive challenge during the initiation of lung cancer treatment. Few patients are willing to sacrifice medical care regardless of the cost. Risk factors for FT evolve, resulting in unique interventional targets throughout therapy.

Adoption of the Antifibrotic Medications Pirfenidone and Nintedanib for Patients with Idiopathic Pulmonary Fibrosis.

Rationale: In October 2014, the antifibrotic medications pirfenidone and nintedanib became the first medications approved by the U.S. Food and Drug Administration for use in patients with idiopathic pulmonary fibrosis (IPF). Since approval, there has been no nonregistry analysis of the real-world adoption of these medications in everyday clinical practice. Objectives: To evaluate the adoption, persistence, and out-of-pocket (OOP) costs of pirfenidone and nintedanib since their approval in the United States in 2014. Methods: A retrospective cohort analysis was performed by identifying privately insured and Medicare Advantage beneficiaries with IPF. We then split the patients into three cohorts: those who were untreated and those who filled a prescription for either pirfenidone or nintedanib between October 1, 2014, and July 31, 2019. The primary outcome was adoption of the medications. Secondary outcomes included medication persistence and prescription drug costs. Results: A total of 10,996 patients with IPF were identified in the data set. A minority of patients (26.4%) with IPF identified in the cohort had started either medication since approval in 2014, with the adoption of both medications being comparable at around 13.2%. Those receiving the medications were younger (72 vs. 73.9 yr; P < 0.0001) and healthier (3.9 vs. 4.9 comorbidities; P < 0.0001) than those not receiving treatment. Men were significantly more likely to receive treatment than woman (30.0% vs. 21.9%; P < 0.0001). Among treated patients, 42.8% discontinued the medications during the study period. Patients' OOP expenses per month were high for both drugs (mean, $397.51 for nintedanib; mean, $394.49 for pirfenidone). Conclusions: The adoption of both the antifibrotic medications in the United States in everyday practice has been low since approval and may be associated with the high OOP cost.

Importance of Evidence-Based Health Insurance Reimbursement and Health Technology Assessment for Achieving Universal Health Coverage and Improved Access to Health in India

ObjectiveTo review the importance of evidence-based methods in health insurance reimbursement for achieving universal health coverage in India. MethodsA narrative literature review was performed. ResultsThe out-of-pocket (OOP) healthcare expenditure in India is among the highest in the world. This situation is despite the implementation of numerous government health schemes and the availability of a large number of health insurance programs, both public and private. Compromised quality of care in many public healthcare facilities is a major factor driving the average Indian citizen to increasingly depend upon private healthcare facilities, further escalating OOP spending. The low awareness and poor uptake of insurance policies among Indians is one of the biggest challenges in the implementation of universal health coverage (UHC) in India. The catastrophic burden of high OOP expenses on individual households could be reduced by taking steps to enhance health insurance uptake, which can be in turn achieved by strengthening the healthcare reimbursement system in India. ConclusionsThe application of the principles of evidence-based healthcare for reimbursement requires the systematic assessment of all health technologies, which is already being done in developed countries. The enactment of health schemes such as Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana and setting up of Health Technology Assessment in India are steps toward reducing OOP expenditure and achieving UHC in India. We review the importance and challenges of evidence-based reimbursement and health technology assessment toward achieving UHC in India.

Patient out-of-pocket costs for suspicious pulmonary nodule biopsy in lung cancer patients

Aims Dynamic changes in the payer landscape have resulted in increasing out-of-pocket costs (OOPC). Little is known about OOPC for patients undergoing biopsy for suspicious pulmonary nodules in the U.S. This study seeks to describe the spectrum of OOPC for diagnostic tissue sampling for suspicious pulmonary nodule with an ultimate diagnosis of lung cancer. Methods Retrospective cohort study of adult patients with a primary lung cancer diagnosis and treatment who underwent diagnostic biopsy for suspicious pulmonary nodule utilizing IBM Marketscan® Databases (2013 to 2017). Claims data included both total hospital and physician billed costs, insurer reimbursement and OOPC. Out-of-pocket costs were further stratified by type of biopsy, whether the patient underwent a single or multiple biopsies, and year of biopsy. Results A total of 22,870 patients age 18-95 who underwent diagnostic lung biopsy were identified. The gender ratio was 49 to 51 for female;male, and 50% of patients were aged 65 or above. 78% of patients had a co-morbidity. The median OOPC for a patient receiving a single biopsy (any type) was $600, two biopsies: $706, three biopsies: $811, four biopsies: $1177. By biopsy type, the median OOPC for a patient requiring a single biopsy was $604 for percutaneous biopsy, $316 for surgical biopsy, $674 for bronchoscopic biopsy, and $545 for mediastinoscopic biopsy. Limitations Under-estimation of OOP expenses from costs of transportation, job loss, and loss of productivity. Over-estimation of OOPC from lack of individual claim adjudication. Conclusion The median OOPC for lung cancer patient requiring a single diagnostic lung biopsy is $600. Prior research indicates that almost 50% of the lung cancer patient population undergoes multiple biopsies increasing costs anywhere between 20-100% resulting in further patient financial burden for each episodic biopsy attempt. Further cost effectiveness research is needed to differentiate various diagnostic technologies for lung biopsy.