Journal Article

Anticipated Out‐Of‐Pocket Costs and Prostate Cancer Management Among Men With Commercial Insurance

Oerline, Mary, Guro, Paula, Maganty, Avinash, Leick, Sarah, Shahinian, Vahakn B., Hill, Dawson C., Shay, Addison, Kaufman, Samuel R., Liu, Xiu, Dall, Christopher, Chachlani, Preeti, Srivastava, Arnav, Hollenbeck, Brent K.

2025

Overview

Introduction Men with newly diagnosed prostate cancer often appropriately elect for either immediate treatment or conservative management. The out‐of‐pocket costs they face vary by management strategy, with immediate treatment often superseding those of conservative management, potentially influencing patient decisions. We estimated the anticipated out‐of‐pocket costs that commercially insured men with newly diagnosed prostate cancer face and measured their association with immediate treatment. Methods From MarketScan, we identified men with newly diagnosed prostate cancer from 2010–2020. Separately, using actual out‐of‐pocket costs (summing deductible, copay, coinsurance) among patients undergoing arthroscopic meniscal repair (n = 383,187), we derived regression coefficients for patient‐level variables (e.g., health plan type) that inform their financial liability. We applied these coefficients to men with prostate cancer and estimated their predicted out‐of‐pocket costs, our main exposure. We sorted patients into quartiles and used logistic regression to calculate adjusted probabilities of immediate treatment (versus conservative management). Results We identified 58,206 men with prostate cancer and rank ordered them by predicted out‐of‐pocket cost. Approximately 12% of men had a predicted out‐of‐pocket cost of zero, and among those with non‐zero cost sharing, the median out‐of‐pocket cost was$350 (IQR: $ 275, $486). Across quartiles of predicted out‐of‐pocket costs, adjusted percentages of immediate treatment were in a narrow range between 77.8% (95% CI: 76.8%, 78.8%) for Quartile 1% and 78.6% (95% CI: 77.7%, 79.5%) for Quartile 4. Conclusion Among commercially insured men with prostate cancer, predicted out‐of‐pocket costs varied substantially. However, the choice of management, immediate treatment or conservative management, appears insensitive (i.e., inelastic) to patient anticipated financial liability.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Aged / Capitation / Conservative Treatment - economics / Disease management / financial toxicity / Health Expenditures - statistics & numerical data / Health insurance / Humans / Insurance coverage / insurance design / Insurance, Health - economics / Insurance, Health - statistics & numerical data / Male / Management decisions / Meniscus / Middle Aged / out‐of‐pocket costs / Prostate cancer / Prostatic Neoplasms - economics / Prostatic Neoplasms - therapy / United States