Patient cost responsibility up for guideline-discordant care

(HealthDay)—For patients with metastatic breast cancer (MBC), receipt of National Comprehensive Cancer Network Guideline-discordant care is associated with higher patient cost responsibility, according to a study published in the October issue of the Journal of the National Comprehensive Cancer Network.

Courtney P. Williams, M.P.H., from the University of Alabama at Birmingham, and colleagues conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results-Medicare linked database from 2000 through 2013. Guideline discordance was assessed for first-line antineoplastic treatment. In women with MBC, patient cost responsibility (deductibles, coinsurance, and copayments) was summed for all medical care received in the year following diagnosis.

The researchers found that 17.6 percent of 3,709 patients with MBC surviving at least one year postdiagnosis received guideline-discordant treatment. In the year postdiagnosis, median cost responsibility was $7,421 and $5,171 for patients receiving guideline-discordant and guideline-concordant care, respectively. In the first year from the index diagnosis date, guideline-discordant treatment was significantly associated with $1,841 higher patient costs compared with guideline-concordant care in adjusted models. There was variation in patient cost responsibility based on category of guideline discordance, with the highest cost responsibility seen for patients receiving nonapproved bevacizumab (β = $3,330).

“Our work can inform efforts to improve patient-clinician communication about the value of guideline-based care and the potential implications of financial burden associated with cancer treatments,” the authors write.

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