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Observational Study
. 2019 Aug;221(2):136.e1-136.e9.
doi: 10.1016/j.ajog.2019.04.005. Epub 2019 Apr 6.

Total and Out-Of-Pocket Costs of Different Primary Management Strategies in Ovarian Cancer

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Observational Study

Total and Out-Of-Pocket Costs of Different Primary Management Strategies in Ovarian Cancer

Rudy S Suidan et al. Am J Obstet Gynecol. .

Abstract

Background: Communicating healthcare costs to patients is an important component of delivering high-quality value-based care, yet cost data are lacking. This is especially relevant for ovarian cancer, where no clinical consensus on optimal first-line treatment exists.

Objective: The objective of this study was to generate cost estimates of different primary management strategies in ovarian cancer.

Study design: All women who underwent treatment for ovarian cancer from 2006-2015 were identified from the MarketScan database (n=12,761) in this observational cohort study. Total and out-of-pocket costs were calculated with the use of all claims within 8 months from initial treatment and normalized to 2017 US dollars. The generalized linear model method was used to assess cost by strategy.

Results: Among patients who underwent neoadjuvant chemotherapy and those who underwent primary debulking, mean adjusted total costs were $113,660 and $107,153 (P<.001) and mean out-of-pocket costs were $2519 and $2977 (P<.001), respectively. Total costs for patients who had intravenous standard, intravenous dose-dense, and intraperitoneal/intravenous chemotherapy were $105,047, $115,099, and $121,761 (P<.001); and out-of-pocket costs were $2838, $3405, and $2888 (P<.001), respectively. Total costs for regimens that included bevacizumab were higher than those without it ($171,468 vs $104,482; P<.001); out-of-pocket costs were $3127 vs $2898 (P<.001). Among patients who did not receive bevacizumab, 25% paid ≥$3875, and 10% paid ≥$6265. For patients who received bevacizumab, 25% paid ≥$4480, and 10% paid ≥$6635. Among patients enrolled in high-deductible health plans, median out-of-pocket costs were $4196, with 25% paying ≥$6680 and 10% paying ≥$9751.

Conclusion: Costs vary across different treatment strategies, and patients bear a significant out-of-pocket burden, especially those enrolled in high-deductible health plans.

Keywords: bevacizumab; chemotherapy; cost; high-deductible health plan; out-of-pocket cost; ovarian cancer.

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