Medicare Patients With Blood Cancer Face High Costs That May Impact Treatment

Although survival rates for older patients with blood cancers have been improving with the introduction of more efficacious and less toxic therapies, rising healthcare costs mean less than half of newly diagnosed patients are receiving treatment for their cancer shortly after diagnosis, according to a new report from Milliman commissioned by The Leukemia & Lymphoma Society (LLS).

The study analyzed costs incurred by Medicare beneficiaries with newly diagnosed acute leukemia, chronic leukemia, lymphoma, multiple myeloma, and bone marrow disorders. The researchers identified 35,877 fee-for-service (FFS) beneficiaries and 1898 beneficiaries with Medicare Advantage with Part D coverage (MAPD) in 2015 using the Medicare Research Identifiable Part A, B, and D FFS database and Milliman’s own proprietary MAPD database.

“Along with the substantial healthcare costs associated with treatment of patients with blood cancer comes substantial OOP [out-of-pocket] costs for patients,” the researchers wrote in the report. “In particular, because of the Medicare Part A, B and D benefit design, the OOP burden can be greater for Medicare beneficiaries compared to commercially insured patients.”

Among the newly diagnosed patients with blood cancer, only 43.7% MAPD beneficiaries and 38.7% in FFS received an anticancer therapy within 90 days of receiving their diagnosis. Patients with lymphoma were most likely to receive therapy (24.7% for MAPD and 21.4% for FFS) and patients with bone marrow disorder were the least likely (2.5% for MAPD and 2.3% for FFS).

In the month of diagnosis, which is the most expensive for all patients with blood cancer, the average spending per FFS beneficiary was $17,719 with acute leukemia costing the most ($35,202) and chronic leukemia costing the least ($11,568). The average spending per MAPD patient was $14,691—acute leukemia still cost the most ($27,253), but bone marrow disorder costing the least ($8,848). However, by the end of 2 years, multiple myeloma had incurred the most costs for MAPD patients ($178,496), with acute leukemia a close second ($177,543).

OOP spending also varied by cancer type, ranging from $588 (chronic leukemia) to $1201 (lymphoma) for MAPD patients in the month of diagnosis and from $1268 (chronic leukemia) to $2144 (multiple myeloma) for FFS patients.

“With the substantial allowed costs incurred by patients newly diagnosed with blood cancer, patients who do not qualify for government subsidies can accumulate significant OOP spending,” according to the report.

By the end of year 2, there was the greatest difference in average OOP spending per patient between MAPD and FFS beneficiaries who had acute leukemia ($7644 vs $21,852) and the smallest difference was for patients with chronic leukemia ($4379 vs $11,224).

“In addition to the emotional impact of dealing with a blood cancer, patients and families often face extraordinary costs in the first year after diagnosis and beyond,” Louis J. DeGennaro, PhD, LLS president and chief executive officer, said in a statement. “The Leukemia & Lymphoma Society hopes that the findings from this new study will prompt payers, providers, patient advocates, and policy makers to work together to address the financial burdens for patients.”

Last year, LLS had commissioned a different study from Milliman on the difference between costs for patients with blood cancer versus other cancers. That study used commercial claims and found patients with blood cancers are burdened with higher costs than those with other cancers, and that those costs persist over time and never drop back to precancer levels.