Breast cancer costs poor people more

Low-income groups’ relative out-of-pocket costs far exceed those paid by wealthy patients

SAN ANTONIO — As a percentage of family income, money spent by U.S. women with breast cancer is much greater for low-income patients than for those who are well off, according to research presented December 12 in Texas at the San Antonio Breast Cancer Symposium.

Public health researcher Lisa Lines of the consulting firm Boston Health Economics in Waltham, Mass., and her colleagues analyzed expenditures made by 806 breast cancer patients from 1996 to 2005. Out-of-pocket costs included insurance premiums, payments to meet deductibles, co-pays and any other payments made to meet medical or drug costs associated with treatment.

The average annual out-of-pocket expenditure was about $2,300 per breast cancer patient, about half of which was spent on prescription drugs.

“Breast cancer is actually not the most expensive cancer for out-of-pocket expenditures,” Lines says. This and other data suggest that breast cancer costs patients more than colon or prostate cancer, but less than lung cancer, she says.

But breast cancer has a large proportion of people with a “high burden,” she says. The researchers classified patients as having a high burden when their out-of-pocket costs for coping with the cancer exceeded 10 percent of the family’s income. Roughly 70 percent of low-income breast cancer patients fell into the high-burden category in this analysis, compared with about 15 percent of middle-income and less than 5 percent of high-income breast cancer patients — apparently the result of better insurance, she says.

Cancer patients in general are disproportionately affected by a high out-of-pocket burden. That’s because many cancers have come to be treated more like a chronic disease than they used to be and are treated on an outpatient basis, Lines says. In the past, most cancer patients were treated in hospitals, where major medical insurance covered much of the cost.

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