High-deductible health plans linked to delayed diagnosis of metastatic cancer
Enrollment in high-deductible health plans (HDHPs) is associated with delays in metastatic cancer diagnosis, according to research presented at the 2022 ASCO Annual Meeting.1
The researchers defined HDHPs as plans in which patients are responsible for all costs until they have spent at least $1,000 a year, said study presenter Nicolas Trad, of Harvard Medical. School in Boston.
Trad cited data suggesting the percentage of U.S. workers enrolled in HDHPs has risen from around 10% in 2006 to nearly 60% in 2021.2 He also cited data suggesting that HDHP enrollees are experiencing delays in diagnostic biopsies and breast cancer imaging, as well as in initiating chemotherapy.3
For the current study, Trad and colleagues investigated whether HDHP participants also experienced a delay in diagnosis of metastatic cancers.1
Study details and results
Researchers looked at insurance claims from 2003 to 2017 for 345,401 people, ages 18 to 64, whose employers required switching from a low-deductible plan ($500 or less per year for individual coverage ) to an HDHP.
The researchers compared the HDHP group to a matched control group of 1,654,775 people whose employers offered only low-deductible plans.
Both groups had a one-year baseline period during which everyone was enrolled in a low-deductible plan. The groups were matched for a variety of demographic, clinical, financial and other parameters, so there were no differences in baseline characteristics between the groups.
Using claims data, researchers assessed the time to diagnosis of metastatic cancer in the baseline (pre-HDHP switch) and follow-up (post-HDHP switch) periods. Patients previously diagnosed with metastatic cancer were not included in the analysis.
During a mean follow-up of 38 months, patients had a total of 1668 metastatic events.
During the year when all patients were on low-deductible diets, there was no significant difference between the groups in the time to diagnosis of metastases (relative risk [HR]0.96; P =.67).
However, after some patients switched to HDHPs, those with HDHPs were less likely to be diagnosed with metastatic cancer than patients who remained on their low-deductible regimen (HR, 0.88, P =.01). This indicates significantly delayed detection in the HDHP group compared to the control group, Trad said.
He noted that, on average, metastatic disease was detected 4.6 months later in patients with HDHP than in patients who kept their low-deductible plans.
Diagnostic delays could delay the start of palliative care and symptom relief therapies, Trad noted. Delays could also lead to further spread of the disease, which limits treatment options.
Trad acknowledged, however, that the impact of diagnostic delays on treatment, quality of life and survival could not be determined with the current study.
Value from the patient’s perspective
Learning a diagnosis of metastatic cancer sooner could mean a lower disease burden early in treatment, which could lead to better outcomes, said study discussant Oluwadamilola Fayanju, MD, of the University of Pennsylvania. in Philadelphia.4
She noted that earlier diagnosis gives patients more time to receive treatment, get their personal affairs in order, grieve, and perhaps die as and where they choose.
On the other hand, some patients might choose HDHP despite the prospect of later diagnosis, Dr. Fayanju said. She pointed out that having cash on hand could be more important than a possible delay in diagnosis. Additionally, getting an earlier diagnosis might not help patients physically, and it might lead to prolonged unemployment, make patients feel like a burden on loved ones, and prolong psychological suffering.
Dr. Fayanju stressed that further research should distinguish metastatic recurrences from de novo diagnoses. The trajectory to that point can impact priority outcomes, she said.
She also noted that some employers may require the selection of an HDHP for their employees. Additional research on clinical outcomes could influence collective advocacy efforts.
Disclosures: Some study authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original reference for a full list of disclosures.
- Trad N, Hassett M, Zhang F, Wharam JF. Impact of high-deductible health plans on delays in diagnosis of metastatic cancer. Featured at ASCO 2022; June 3-7, 2022. Summary 6503.
- Employer Health Benefits Survey 2021. Kaiser Family Foundation. Published November 10, 2021. Accessed June 24, 2022. https://www.kff.org/report-section/ehbs-2021-summary-of-findings/
- Wharam JF, Zhang F, Lu CY, et al. Diagnosis and treatment of breast cancer after taking out high-deductible insurance. J Clin Oncol. 2018;36(11):1121-1127. doi:10.1200/JCO.2017.75.2501
- Fayanju OM. Assessing Real Value: The Impact of Health Insurance on Cancer Care Delivery. Featured at ASCO 2022; June 3-7, 2022.