OUT-OF-POCKET COST BURDEN AMONG PATIENTS DIAGNOSED WITH BREAST CANCER AND MENTAL HEALTH COMORBIDITIES: A CROSS-SECTIONAL STUDY USING MEDICAL EXPENDITURE PANEL SURVEY (MEPS) DATA
Author(s)
Neel Vaidya, MS, Ali Bonakdar, PharmD, MPH, PhD, RPh, Keshab Subedi, MS;
Cencora, Inc., Conshohocken, PA, USA
Cencora, Inc., Conshohocken, PA, USA
OBJECTIVES: Breast cancer (BC) imposes a substantial financial burden on patients, with out-of-pocket (OOP) costs reaching $3.14 billion, according to the National Cancer Institute. Mental health (MH) comorbidities, including anxiety and mood disorders have shown to exacerbate this burden. This study compared OOP costs among BC patients with and without MH comorbidities, stratified by federal poverty levels (FPL).
METHODS: We analyzed pooled data from the Medical Expenditure Panel Survey (2018-2022), comprising non-institutionalized U.S. adults diagnosed with BC, with or without MH comorbidities. Sampling weights and Census Bureau population controls were applied. Annual OOP costs per patient were adjusted to 2022 U.S. dollars. Demographics and clinical characteristics were summarized using descriptive statistics. The OOP costs were compared using survey-weighted Wilcoxon rank-sum tests.
RESULTS: The study included 1,509,242 BC patients (weighted), of whom 30.9% (n=466,789) had MH comorbidities. The median age was 68 years, 77% were white, and 36.8% had public insurance coverage. Patients with MH comorbidities were more likely to have dual Medicare and Medicaid coverage (10.1% vs. 5.7%), vs without MH comorbidities. Overall, BC patients with MH comorbidities had 83% higher annual median OOP costs vs without MH ($1,821 vs. $996; p<0.05), consuming a larger share of income (median, 2.2% vs. 1.4%, p<0.05). Stratified analyses by income levels revealed heterogeneous effects. Among higher-income patients (>400% FPL), median OOP costs were 112% higher ($2,630 vs. $1,239, p<0.05). Middle-income patients (251-400% FPL) experienced a 185% increase in median costs ($1,932 vs. $677, p=0.03). For lower-income patients (≤138% FPL), OOP costs accounted for twice the share of their income (median, 3.62% vs. 1.97%) (p=0.08) vs without MH comorbidities.
CONCLUSIONS: BC patients with MH comorbidities face significantly higher OOP costs across incomes, greatest in absolute terms for higher-income groups and proportionally for lower-income groups. Policies promoting integrated care and enhanced financial assistance are urgently needed.
METHODS: We analyzed pooled data from the Medical Expenditure Panel Survey (2018-2022), comprising non-institutionalized U.S. adults diagnosed with BC, with or without MH comorbidities. Sampling weights and Census Bureau population controls were applied. Annual OOP costs per patient were adjusted to 2022 U.S. dollars. Demographics and clinical characteristics were summarized using descriptive statistics. The OOP costs were compared using survey-weighted Wilcoxon rank-sum tests.
RESULTS: The study included 1,509,242 BC patients (weighted), of whom 30.9% (n=466,789) had MH comorbidities. The median age was 68 years, 77% were white, and 36.8% had public insurance coverage. Patients with MH comorbidities were more likely to have dual Medicare and Medicaid coverage (10.1% vs. 5.7%), vs without MH comorbidities. Overall, BC patients with MH comorbidities had 83% higher annual median OOP costs vs without MH ($1,821 vs. $996; p<0.05), consuming a larger share of income (median, 2.2% vs. 1.4%, p<0.05). Stratified analyses by income levels revealed heterogeneous effects. Among higher-income patients (>400% FPL), median OOP costs were 112% higher ($2,630 vs. $1,239, p<0.05). Middle-income patients (251-400% FPL) experienced a 185% increase in median costs ($1,932 vs. $677, p=0.03). For lower-income patients (≤138% FPL), OOP costs accounted for twice the share of their income (median, 3.62% vs. 1.97%) (p=0.08) vs without MH comorbidities.
CONCLUSIONS: BC patients with MH comorbidities face significantly higher OOP costs across incomes, greatest in absolute terms for higher-income groups and proportionally for lower-income groups. Policies promoting integrated care and enhanced financial assistance are urgently needed.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE475
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology