The rising cost of care is having a negative impact on patients with bladder cancer, but a value-based approach to care might provide some relief, according to a pair of presentations at the 2023 ASCO Genitourinary Cancers Symposium.1,2
One of the presenters, Vidit Sharma, MD, of the Mayo Clinic in Rochester, Minnesota, highlighted a SEER-Medicare analysis showing that costs of bladder cancer care are increasing.1,3 The projected costs to Medicare will rise to 11.6 billion dollars by 2030 — not inclusive of additional charges from yet-to-be-approved therapeutic agents, Dr Sharma noted.
He also cited a review characterizing the economic burden of cancer in the United States.4 The review showed that patients must pay not only the direct out-of-pocket costs for their medical care but also indirect costs from travel, lodging, and fees paid to entities other than health care providers.
From a societal viewpoint, a bladder cancer diagnosis is even more costly. Total costs include both direct costs to payers and patients and the costs from reduced productivity and unpaid leave for patients and caregivers who require absences from work to accommodate medical care.
“[T]he costs that we can measure — and these are the direct costs that we usually measure — are often the tip of the iceberg of the costs that our patients usually face,” Dr Sharma said.
Negative Impact of Financial Toxicity
Dr Sharma highlighted a survey of 138 patients with bladder cancer, which showed that nearly 1 in 4 experienced financial toxicity.5 Financial toxicity was defined as “having to pay more for medical care than you can afford.”
Younger patients, Black patients, and those without a college degree had a higher risk of financial toxicity. However, in a multivariate analysis, only younger age was associated with financial toxicity. The study authors speculated that the higher risk of financial toxicity in younger patients may be due to loss of work-related income and lack of universal health insurance coverage.
Financial toxicity had negative effects on traditional cancer outcomes as well. Patients who reported financial toxicity were more likely to delay care than patients who did not report financial toxicity (39% vs 23%; P =.07).
Patients with financial toxicity also reported significantly worse physical health (P =.03), mental health (P <.01), cancer-specific health-related quality of life (P =.01), physical well-being (P =.01), and functional well-being (P =.05).
Dr Sharma noted that patients with all stages of bladder cancer require surveillance and treatment. If complications or cancer progression occur, higher cumulative costs are the result.
He recommended that clinicians explore financial concerns with their patients to identify those who are at risk of financial toxicity and refer them to appropriate resources — ideally before treatment commences.