Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
James Frank WharamDennis Ross-Degnan

Abstract

Purpose High-deductible health plans (HDHPs) require substantial out-of-pocket spending and might delay crucial health services. Breast cancer treatment delays of as little as 2 months are associated with adverse outcomes. Methods We used a controlled prepost design with survival analysis to assess timing of breast cancer care events among 273,499 women age 25 to 64 years without evidence of breast cancer before inclusion. Women were included if continuously enrolled for 1 year in a low-deductible ($0 to $500) plan followed by up to 4 years in a HDHP (at least $1,000 deductible) after an employer-mandated switch. Study inclusion was on a rolling basis, and members were followed between 2003 and 2012. The comparison group comprised 2.4 million contemporaneously matched women whose employers offered only low-deductible plans. Measures were times to first diagnostic breast imaging (diagnostic mammogram, breast ultrasound, or breast magnetic resonance imaging), breast biopsy, incident early-stage breast cancer diagnosis, and breast cancer chemotherapy. Outcomes were analyzed by using Cox models and adjusted for age-group, morbidity score, poverty level, US region, index date, and employer size. Results After the index date, HDHP me...Continue Reading

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Citations

May 14, 2018·Breast Cancer Research and Treatment·Christine Y LuJ Frank Wharam
Nov 21, 2018·Annals of Internal Medicine·J Frank WharamJoseph P Newhouse
Dec 18, 2018·Pediatric Blood & Cancer·Susan K Parsons, Anita J Kumar
Jan 22, 2019·Cancer·Zhiyuan ZhengK Robin Yabroff
Nov 8, 2018·Annual Review of Public Health·Olena MazurenkoNir Menachemi
Jun 5, 2019·Journal of Oncology Practice·Robert D SiegelKristina M Stoeppler-Biege
Jul 30, 2019·Journal of Oncology Practice·Rachel A GreenupE Shelley Hwang
Dec 6, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Scott F HuntingtonCary P Gross
Aug 14, 2020·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Manali I PatelWilliam Tap
May 27, 2020·American Society of Clinical Oncology Educational Book·K Robin YabroffA Mark Fendrick
Jul 24, 2020·Journal of General Internal Medicine·David H Jiang, Rozalina G McCoy
Feb 21, 2019·CA: a Cancer Journal for Clinicians·K Robin YabroffOtis W Brawley
Oct 8, 2020·Health Services Research·Shih-Chuan ChouJ Frank Wharam
Apr 21, 2021·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Vanessa F TorrecillasJeremy D Meier
Nov 13, 2019·Annals of Surgery·Karan R ChhabraDana A Telem
Jul 11, 2021·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·David H JiangRozalina G McCoy
Sep 17, 2021·Annals of Surgical Oncology·Evan Matros, Anaeze C Offodile

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