Burden of High-Deductible Health Plans May Delay Breast Cancer Diagnosis

The cost-sharing burden of high-deductible health plans (HDHPs) may delay breast cancer diagnosis, according to researchers.

The researchers found that breast cancer patients with HDHPs presented with a higher grade of tumor and were more likely to be treated with neoadjuvant chemotherapy than patients with low-deductible health plans (LDHPs).  

These findings were published in Clinical Breast Cancer.

This study included 507 patients who underwent bilateral mastectomy and breast reconstruction at the University of Texas Southwestern Medical Center in Dallas. Slightly more patients had LDHPs (n=262) than HDHPs (n=245).

There were no significant differences between the groups with regard to age, race, cancer type, genetic mutations, HER2 positivity, estrogen receptor positivity, or progesterone receptor positivity.

There was no significant difference between the groups with regard to cancer stage, but patients with HDHPs were significantly more likely to have grade 3 tumors (P =.036). Patients with HDHPs were also more likely to have larger tumors, but this difference did not reach statistical significance (P =.060).

There were no significant differences between the groups in the use of prophylactic mastectomy, radiation, or adjuvant therapy. However, patients with HDHPs were more likely than those with LDHPs to receive neoadjuvant chemotherapy (36.8% and 25.7%, respectively; P <.01).     

The researchers theorized that patients with HDHPs were more likely to receive neoadjuvant chemotherapy because their higher out-of-pocket costs likely delayed breast cancer screening. This theory is supported by the fact that patients with HDHPs presented with a significantly higher grade of tumor and borderline-significant larger tumor sizes at diagnosis.

The researchers found no significant differences between the HDHP and LDHP groups in selecting autologous-based breast reconstruction or implant-based breast reconstruction. The groups also had a similar number of operating room visits, total number of revisionary procedures, and length of reconstruction in days or calendar years.

The average deductible was $546.74 in the LDHP group and $3175.74 in the HDHP group.

The average out-of-pocket maximum cost was significantly lower for patients with LDHPs ($4212.30) than for those with HDHPs ($5226.65; P <.0001). On linear regression, there was no significant association between increasing out-of-pocket maximum cost and total number of operating room visits or breast revisions.

The average co-insurance for a surgical procedure was significantly lower for patients with LDHPs (4.52%) than for those with HDHPs (6.92%, P <.01). There was no association between surgical co-insurance and the number of revisionary procedures, operating room visits, or the length of reconstruction.

“As the cost-sharing burden of high-deductible health plans creates the potential for patients to forego necessary care, it is important to put effort towards increasing patient education concerning health plan benefits, especially for vulnerable populations,” the researchers wrote. “As increased health insurance literacy has been associated with a lower likelihood of delayed care owing to cost, future directions should include not only increased education but also evaluations of the efficacy of these educational strategies.”

Reference

Jones KD, Lakatta AC, Haddock NT, Teotia SS. The effects of high deductible health plans on breast cancer treatment and reconstruction. Clin Breast Cancer. Published online August 24, 2023. doi:https://doi.org/10.1016/j.clbc.2023.08.006

This article originally appeared on Cancer Therapy Advisor