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The Association Between High Deductible Health Plans and Cancer Survival
A group of researchers evaluated how high deductible health plans (HDHP) are associated with survival in patients with cancer and presented their findings at ASCO 2024. They pulled data from the 2011-2018 National Health Insurance Interview Survey (NHIS) of individuals within the age range 18-84 who had non-Medicaid insurance and linked mortality files from the National Death Index. There were a total 147 254 survey respondents included in the study.
Researchers used Cox proportional hazards models to determine the association of HDHP status with overall survival (OS) and cancer survival (CS) among cancer survivors. They also investigated HDHP associations for people with cancer who did not have cancer history compared to cancer survivors. An insurance plan ≥$1200-$1350 was considered a HDHP for an individual, and a HDHP plan for a family was ≥$2400-$2700.
Of the total number of survey respondents, 5.9% were cancer survivors. Of the survivors, 25.6% reported being insured by a HDHP when completing the survey. The findings for this group showed that HDHP status was associated with worse OS (HR = 1.46; 95%, CI = 1.19-1.79) and CS (HR = 1.34; 95%, CI = 1.01-1.77). Among the survivors, the study also found that HDHP status was associated with worse OS for non-Hispanic White (HR = 1.45; 95%, CI = 1.16-1.82) patients; those whose income was >400% the federal poverty level (HR = 1.65; 95%, CI = 1.16-2.36); those with college (HR = 1.47; 95%, CI = 1.07-2.00) or high school (HR = 1.59; 95%, CI = 1.19-2.12) education; and those with multiple cancers (HR = 1.58; 95%, CI = 1.06-2.36). The researchers did not identify clear patterns by sex, comorbidities, insurance, and cancer site for these subgroup results.
There were 28.5% of individuals without a cancer history who reported being insured by a HDHP. In contrast to the survival cohort, HDHP status was not significantly associated with OS (HR = 1.08; 0.96-1.21; P-interaction < .01) or CS (HR = 0.90; 95%, CI = 0.70-1.14; P-interaction < 01) for those without a cancer history.
Overall, the study found that HDHPs are associated with both worse OS and CS among cancer survivors. However, they were not found to be associated with survival in adults without a history of cancer.
“HDHPs may financially disincentivize cancer survivors from utilizing necessary medical care to optimize survivorship thereby compromising mortality and cure,” said the authors. They suggest implementing policies to reduce the use of such plans to improve these patients’ outcomes.
Reference
Barnes JM, Garcia Santos PM, Wallingford S, Gupta A, Ragavan MV, Chino F. High deductible health plans and survival among cancer survivors. Presented at the 2024 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2024. Chicago, Illinois, and virtual.
