Physicians Must Consider the Financial Burden Associated with Allogeneic Transplants

Wayne Kuznar

February 2014, Vol 5, No 1 - Economics of Cancer Care


New Orleans, LA—Recipients of allogeneic hematopoietic cell transplant are at high risk for financial burden, according to survey-based data collected by Nandita Khera, MD, MPH, a medical oncologist from the Blood and Marrow Transplant Program, Mayo Clinic Arizona, Phoenix, and colleagues.
The reasons include prolonged hospital stays, living away from home, high out-of-pocket (OOP) costs, ex­tended duration of work loss for the patient and caregiver, and the occurrence of chronic medical problems, including complications from the transplant.

“One of the implications from the study is that, as healthcare providers, we need to be aware of the financial burden of allogeneic transplant, which is an important nonmedical complication of the transplant,” said Dr Khera.

To measure the financial toll on patients, Dr Khera and colleagues conducted a cross-sectional survey-­based study with 268 (of 482) eligible patients responding. The team used a 25-item questionnaire to measure sociodemographic information, as well as OOP expenses and medication copays, financial burden, and impact on medical care.

The median age of respondents was 55 years, and 51% of the total respondents were male. The study population was 95% white and 97% non-Hispanic, and 51% had unrelated donor transplants, 58% had reduced-inten­sity conditioning regimens, and 49% had acute leukemia. The median follow-up time was 2.3 years.

Some 29% of patients reported working full time or going to school, in contrast to 69% of patients who had reported being a full-time worker or student before the transplant. A total of 31% of patients reported being on medical disability, and 72% had a monthly median household income of >$2000.
Of the 255 patients with available financial information, all were insured: 59% had private insurance, 4% Med­i­caid, 4% miscellaneous, and 33% had Medicare with supplemental coverage.

Overall, 73% of patients said that being sick had hurt them financially. In addition, 33% of patients believed that they did not have enough money to take care of healthcare needs, or that their medicines were too expensive, and 22% reported being unable to pay their medical bills.

As a result of their medical bills, 13% of patients reported having had to sell stocks or other investments; 25% had to withdraw money from a retirement account; 9% had to refinance a mortgage, take a second mortgage, or sell their house; and 3% had to declare bankruptcy.

The OOP costs for 3 months were >$2000 for 38% of patients and >$5000 for 12% of patients. The median monthly medication copayments were $100 (range, $0-$3000).

Of the patients, 19% reported cutting back on or not purchasing their prescription medications, 21% reported not making a physician appointment or having a medical test performed, and 28% deferred the use of a medical service (eg, physical therapy).

“We need to recognize the vulnerable patients who are at risk for catastrophic economic outcomes for self and their families. We also need to be able to offer potential interventions like early and frequent financial counseling or connecting them to appro­priate services for health,” Dr Khera suggested.