Estimation of Patient Out-of-Pocket Cost for Radiation Therapy by Insurance Type and Treatment Modality

Abstract

Purpose: Financial toxicity is increasingly identified as an important issue in cancer care. Limited data are available on direct out of pocket (OOP) costs for radiation therapy, which are important for providers and patients.

Methods and materials: Retrospective analysis of 247 consecutive patients with nonmetastatic breast and prostate cancer treated with curative intent. Data were collected on demographics, treatments received and insurance plan specifications, including annual OOP maximum, deductibles, co-insurance rates, OOP already paid prior to starting radiation therapy, and actual estimated OOP for radiation therapy. Multivariable logistic regression was used to examine associations between insurance factors, radiation technique, concurrent systemic therapy, and month of treatment with a patient reaching OOP maximum with radiation treatment.

Results: In the study, 137 and 110 patients with breast and prostate cancer were evaluated. Mean plan specified annual OOP maximum for commercial and Medicare Advantage plans were $4064 and $4661, respectively; 100% of commercially insured patients and 54.7% Medicare Advantage patients reached their OOP maximum with radiation therapy. Annual OOP maximum for Medicare plus supplement, Medicaid, and Tricare were minimal. On multivariable analysis, concurrent systemic therapy (odds ratio 6.20, P = .03) was associated with patient reaching OOP maximum, but radiation technique was not.

Conclusions: Out of pocket cost for radiation therapy services may be reasonably estimated based on insurance type and structure. Medicare plus supplement and Medicaid plans have negligible OOP, while all patients with commercial plans reached annual OOP maximums. This study provides practical information to help providers to better counsel patients.