The United States spends significantly more on health care compared to other nations with no indications of slowing down. In 2019, US health care costs were 18% of the gross domestic product. In 2016, while the United States was first in health care spending, the United States was also last in health care access and quality. This high cost of health care not only stresses the US economy, but also the average citizen through higher out-of-pocket costs, as well as hindering efforts to improve access and quality of care. Articles in this issue examine attitudes around financial toxicity as well as the financial burden of specific treatments and services in the growing older adult population.
The prevalence of over-active bladder (OAB) and/or urinary incontinence in the 65 years and older population is high, especially in long-term care (LTC) facilities. Adults ≥65 years with OAB are also more likely to have comorbid conditions and subsequent polypharmacy vs those without OAB. Richard G Stefanacci, DO, and colleagues describe and evaluate the population, treatment patterns, healthcare resource utilization (HCRU), and costs associated with OAB in the LTC setting in the United States (page 34). Specific objectives included evaluating the burden of illness of OAB by examining differences in direct HCRU and costs among residents with OAB compared to a matched cohort of residents without OAB. They also evaluated the HCRI and cost of residents with OAB who were treated vs non-treated. Overall, OAB is associated with a significant HCRU and economic burden in the LTC setting. Also, treating OAB resulted in reduced HCRU and costs compared to untreated OAB, highlighting the need for better treatment management.
“Financial toxicity” in cancer treatment describes out-of-pocket (OOP) costs, such as copayments, deductibles, and coinsurance, that may cause financial problems for a patient. Studies have shown that patients undergoing cancer treatment or survivorship experience higher OOP costs compared to nonelderly adults with or without chronic medical conditions; insured patients with a new cancer diagnosis may incur OOP expenditures totaling about a quarter of their household income. While the financial burden associated with cancer care is well-recognized, few studies have qualitatively explored defining a clinician’s role, if any, in identifying patients at higher risk for financial toxicity and how to standardize communication on cancer treatment costs. In their study, Sylvia T Zhang, MS, and colleagues evaluated the attitudes, motivation, and experiences of clinicians regarding screening for financial toxicity in a medical oncology clinical setting and identify potential opportunities for future clinician-led interventions to mitigate financial hardship (page 43).
A fitting accompaniment to Zhang et al, the Pharma Insights column for this issue underscores the importance of qualitative research to fully comprehend the implications of treatment decisions, outcomes, and value assessments (page 31). Despite the strengths and historical dominance of quantitative research in the health care domain, the importance of rigorous qualitative research as both a complement to, and a mechanism for, augmenting quantitative methods is increasingly being recognized and used across health-related disciplines.
