Developing National Estimates of the Out-of-Pocket Costs of Cancer: The Importance of Including Patients with Lymphoma.

Background: While Congress has mandated that the NIH provide a national estimate of the cost of cancer, almost all cancer cost studies have focused exclusively on breast cancer. No study has reported comparison data for persons with Hodgkin’s disease (HD) or non-Hodgkin’s lymphoma (NHL). These illnesses have a high cure rate, and affected persons are likely to experience significant economic hardships. Many participate in the workforce during treatment and long after the treatment is complete. Herein, we report preliminary results from an ongoing study on the out-of-pocket direct medical and non-medical costs for a cohort of patients with lymphoma and provide contextual comparison with a cohort of breast cancer patients who received care at the same cancer center (Arozullah, Supportive Oncology, 2004).

Methods: 178 breast cancer and lymphoma patients provided information on out-of-pocket costs for the preceding 3-month period; 12% had a diagnosis of HD or NHL. In total, 120 lymphoma patients will be interviewed for this study. Direct medical costs are costs related to medical care such as medications, procedures, and doctor visits. Direct non-medical costs are costs related to cancer, but not medical care, such as costs for meals, transportation, parking, and phone calls.

Results: The majority of both lymphoma and breast cancer patients were < 65 years old, married, and employed. All patients had healthcare insurance coverage, with the majority insured with private plans. In comparison to women with breast cancer, persons with HD/NHL had similar mean monthly out-of-pocket cost expenditures, $635 versus $728. For lymphoma patients, factors associated with high direct medical costs included ≤ 12^th grade education ($1,585/month) and HD ($1,133/month).

Conclusion: Mean monthly out-of-pocket expenditures are similar for HD/NHL and breast cancer. Direct medical out-of-pocket expenditures for lymphoma vary. Direct medical expenditures are greatest for HD ($1,130), intermediate for aggressive NHL and breast cancer ($512–$597), and lowest for indolent NHL ($180). Comprehensive economic analyses of cancer should include a range of malignancies.

Average Monthly Out-of-Pocket Costs for Lymphoma and Breast Cancer Patients.