Cancer History, Health Insurance Coverage, and Cost-Related Medication Nonadherence and Medication Cost-Coping Strategies in the United States
To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage. We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909...
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| Veröffentlicht in: | Value in health 2019-07, Vol.22 (7), p.762-767 |
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| creator | Zhao, Jingxuan Zheng, Zhiyuan Han, Xuesong Davidoff, Amy J. Banegas, Matthew P. Rai, Ashish Jemal, Ahmedin Yabroff, K. Robin |
| description | To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage.
We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking less, or delaying medication because of cost, and (2) cost-coping strategies, measured as requesting lower cost medication or using alternative therapies to save money. Separate multivariable logistic regressions were used to calculate the adjusted odds ratios (AORs) of CRN and cost-coping strategies associated with cancer history, stratified by insurance.
Cancer survivors were more likely than adults without a cancer history to report CRN (AOR 1.26; 95% confidence interval [CI] 1.10-1.43) and cost-coping strategies (AOR 1.10; 95% CI 0.99-1.19). Among the privately insured, the difference in CRN by cancer history was the greatest among those enrolled in high-deductible health plans (HDHPs) without health savings accounts (HSAs) (AOR 1.78; 95% CI 1.30-2.44). Among adults with HDHP and HSA, cancer survivors were less likely to report cost-coping strategies (AOR 0.62; 95% CI 0.42-0.90). Regardless of cancer history, CRN and cost-coping strategies were the highest for those uninsured, enrolled in HDHP without HSA, and without prescription drug coverage under their health plan (all P |
| doi_str_mv | 10.1016/j.jval.2019.01.015 |
| format | Article |
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We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking less, or delaying medication because of cost, and (2) cost-coping strategies, measured as requesting lower cost medication or using alternative therapies to save money. Separate multivariable logistic regressions were used to calculate the adjusted odds ratios (AORs) of CRN and cost-coping strategies associated with cancer history, stratified by insurance.
Cancer survivors were more likely than adults without a cancer history to report CRN (AOR 1.26; 95% confidence interval [CI] 1.10-1.43) and cost-coping strategies (AOR 1.10; 95% CI 0.99-1.19). Among the privately insured, the difference in CRN by cancer history was the greatest among those enrolled in high-deductible health plans (HDHPs) without health savings accounts (HSAs) (AOR 1.78; 95% CI 1.30-2.44). Among adults with HDHP and HSA, cancer survivors were less likely to report cost-coping strategies (AOR 0.62; 95% CI 0.42-0.90). Regardless of cancer history, CRN and cost-coping strategies were the highest for those uninsured, enrolled in HDHP without HSA, and without prescription drug coverage under their health plan (all P<.001).
Cancer survivors are prone to CRN and more likely to use cost-coping strategies. Expanding options for health insurance coverage, use of HSAs for those with HDHP, and enhanced prescription drug coverage may effectively address CRN.
•Policy makers, healthcare providers, and patients are increasingly concerned about rising out-of-pocket costs for prescription drugs and cost-related medication nonadherence (CRN). Previous studies have demonstrated that cancer survivors are more likely than adults without a cancer history to experience high out-of-pocket costs and medical financial hardship.•In this study, we used the most recent nationally representative data to evaluate the complex relationship between cancer history, health insurance coverage, and cost-related changes in medication use, including both CRN and cost-coping strategies among individuals aged 18 to 64 years.•We found that cancer survivors were more likely to report CRN than were similar individuals without a cancer history. Intervention strategies to address CRN may be warranted for cancer survivors. Regardless of cancer history, CRN and cost-coping strategies were the highest for the uninsured, those with high-deductible health plans without health savings accounts, or those without prescription drug coverage under their health plan. Expanding options for health insurance coverage, use of health savings accounts for those with high-deductible health plans, and enhanced prescription drug coverage among the insured may be effective strategies to address CRN.</description><identifier>ISSN: 1098-3015</identifier><identifier>EISSN: 1524-4733</identifier><identifier>DOI: 10.1016/j.jval.2019.01.015</identifier><identifier>PMID: 31277821</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Adults ; Alternative medicine ; Antineoplastic Agents - economics ; Antineoplastic Agents - therapeutic use ; Cancer ; Cancer Survivors - psychology ; Cancer therapies ; Confidence intervals ; Coping strategies ; Cost Savings ; cost-coping strategies ; cost-related medication nonadherence ; Deductibles and Coinsurance - economics ; Drug Substitution - economics ; Drugs, Generic - economics ; Drugs, Generic - therapeutic use ; Female ; Health care expenditures ; Health Care Surveys ; Health Expenditures ; Health insurance ; Health Knowledge, Attitudes, Practice ; health saving accounts ; Health savings accounts ; high-deductible health plan ; Humans ; Insurance coverage ; Insurance Coverage - economics ; Insurance, Health - economics ; Male ; Medical Savings Accounts ; Medication Adherence ; medications ; Middle Aged ; Money ; National Health Interview Survey ; Neoplasms - drug therapy ; Neoplasms - economics ; Neoplasms - epidemiology ; Neoplasms - psychology ; out-of-pocket costs ; Patient compliance ; Prescription drugs ; Prone ; Savings accounts ; Survivor ; Time Factors ; United States - epidemiology ; Young Adult</subject><ispartof>Value in health, 2019-07, Vol.22 (7), p.762-767</ispartof><rights>2019 ISPOR–The Professional Society for Health Economics and Outcomes Research</rights><rights>Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Jul 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-a16ea1c1a130acec401c7d1f434ee427fbce5c056e3621d84aa2f4c0a72010073</citedby><cites>FETCH-LOGICAL-c428t-a16ea1c1a130acec401c7d1f434ee427fbce5c056e3621d84aa2f4c0a72010073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jval.2019.01.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,30978,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31277821$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhao, Jingxuan</creatorcontrib><creatorcontrib>Zheng, Zhiyuan</creatorcontrib><creatorcontrib>Han, Xuesong</creatorcontrib><creatorcontrib>Davidoff, Amy J.</creatorcontrib><creatorcontrib>Banegas, Matthew P.</creatorcontrib><creatorcontrib>Rai, Ashish</creatorcontrib><creatorcontrib>Jemal, Ahmedin</creatorcontrib><creatorcontrib>Yabroff, K. Robin</creatorcontrib><title>Cancer History, Health Insurance Coverage, and Cost-Related Medication Nonadherence and Medication Cost-Coping Strategies in the United States</title><title>Value in health</title><addtitle>Value Health</addtitle><description>To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage.
We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking less, or delaying medication because of cost, and (2) cost-coping strategies, measured as requesting lower cost medication or using alternative therapies to save money. Separate multivariable logistic regressions were used to calculate the adjusted odds ratios (AORs) of CRN and cost-coping strategies associated with cancer history, stratified by insurance.
Cancer survivors were more likely than adults without a cancer history to report CRN (AOR 1.26; 95% confidence interval [CI] 1.10-1.43) and cost-coping strategies (AOR 1.10; 95% CI 0.99-1.19). Among the privately insured, the difference in CRN by cancer history was the greatest among those enrolled in high-deductible health plans (HDHPs) without health savings accounts (HSAs) (AOR 1.78; 95% CI 1.30-2.44). Among adults with HDHP and HSA, cancer survivors were less likely to report cost-coping strategies (AOR 0.62; 95% CI 0.42-0.90). Regardless of cancer history, CRN and cost-coping strategies were the highest for those uninsured, enrolled in HDHP without HSA, and without prescription drug coverage under their health plan (all P<.001).
Cancer survivors are prone to CRN and more likely to use cost-coping strategies. Expanding options for health insurance coverage, use of HSAs for those with HDHP, and enhanced prescription drug coverage may effectively address CRN.
•Policy makers, healthcare providers, and patients are increasingly concerned about rising out-of-pocket costs for prescription drugs and cost-related medication nonadherence (CRN). Previous studies have demonstrated that cancer survivors are more likely than adults without a cancer history to experience high out-of-pocket costs and medical financial hardship.•In this study, we used the most recent nationally representative data to evaluate the complex relationship between cancer history, health insurance coverage, and cost-related changes in medication use, including both CRN and cost-coping strategies among individuals aged 18 to 64 years.•We found that cancer survivors were more likely to report CRN than were similar individuals without a cancer history. Intervention strategies to address CRN may be warranted for cancer survivors. Regardless of cancer history, CRN and cost-coping strategies were the highest for the uninsured, those with high-deductible health plans without health savings accounts, or those without prescription drug coverage under their health plan. Expanding options for health insurance coverage, use of health savings accounts for those with high-deductible health plans, and enhanced prescription drug coverage among the insured may be effective strategies to address CRN.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Adults</subject><subject>Alternative medicine</subject><subject>Antineoplastic Agents - economics</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Cancer</subject><subject>Cancer Survivors - psychology</subject><subject>Cancer therapies</subject><subject>Confidence intervals</subject><subject>Coping strategies</subject><subject>Cost Savings</subject><subject>cost-coping strategies</subject><subject>cost-related medication nonadherence</subject><subject>Deductibles and Coinsurance - economics</subject><subject>Drug Substitution - economics</subject><subject>Drugs, Generic - economics</subject><subject>Drugs, Generic - therapeutic use</subject><subject>Female</subject><subject>Health care expenditures</subject><subject>Health Care Surveys</subject><subject>Health Expenditures</subject><subject>Health insurance</subject><subject>Health Knowledge, Attitudes, Practice</subject><subject>health saving accounts</subject><subject>Health savings accounts</subject><subject>high-deductible health plan</subject><subject>Humans</subject><subject>Insurance coverage</subject><subject>Insurance Coverage - economics</subject><subject>Insurance, Health - economics</subject><subject>Male</subject><subject>Medical Savings Accounts</subject><subject>Medication Adherence</subject><subject>medications</subject><subject>Middle Aged</subject><subject>Money</subject><subject>National Health Interview Survey</subject><subject>Neoplasms - drug therapy</subject><subject>Neoplasms - economics</subject><subject>Neoplasms - epidemiology</subject><subject>Neoplasms - psychology</subject><subject>out-of-pocket costs</subject><subject>Patient compliance</subject><subject>Prescription drugs</subject><subject>Prone</subject><subject>Savings accounts</subject><subject>Survivor</subject><subject>Time Factors</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>1098-3015</issn><issn>1524-4733</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNp9kc2KFDEUhYMozo--gAsJuHEx1eavKt3gZigce2BUcJx1yCS3ulNUJ22SapiX8JlN7FHEhXAhyb3fOYR7EHpFyYIS2r0bF-NBTwtG6GpBaKn2CTqlLRONkJw_LXeyWja89E_QWUojIaTjrH2OTjhlUi4ZPUU_eu0NRLx2KYf4cIHXoKe8xdc-zbGOcB8OEPUGLrD2trxSbr7CpDNY_AmsMzq74PHn4LXdQoQqqeBfs1-aPuyd3-DbHIt04yBh53HeAr7zrnrd5tJPL9CzQU8JXj6e5-ju6sO3ft3cfPl43V_eNEawZW407UBTQzXlRBswglAjLR0EFwCCyeHeQGtI2wHvGLVLoTUbhCFalmURIvk5env03cfwfYaU1c4lA9OkPYQ5KcZazmTH2Kqgb_5BxzBHX35XqK6VFSOFYkfKxJBShEHto9vp-KAoUTUtNaqalqppKUJLtUX0-tF6vt-B_SP5HU8B3h8BKLs4OIgqGVdXbF0Ek5UN7n_-PwEMUKZg</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Zhao, Jingxuan</creator><creator>Zheng, Zhiyuan</creator><creator>Han, Xuesong</creator><creator>Davidoff, Amy J.</creator><creator>Banegas, Matthew P.</creator><creator>Rai, Ashish</creator><creator>Jemal, Ahmedin</creator><creator>Yabroff, K. Robin</creator><general>Elsevier Inc</general><general>Elsevier Science Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>201907</creationdate><title>Cancer History, Health Insurance Coverage, and Cost-Related Medication Nonadherence and Medication Cost-Coping Strategies in the United States</title><author>Zhao, Jingxuan ; Zheng, Zhiyuan ; Han, Xuesong ; Davidoff, Amy J. ; Banegas, Matthew P. ; Rai, Ashish ; Jemal, Ahmedin ; Yabroff, K. Robin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-a16ea1c1a130acec401c7d1f434ee427fbce5c056e3621d84aa2f4c0a72010073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Adults</topic><topic>Alternative medicine</topic><topic>Antineoplastic Agents - economics</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Cancer</topic><topic>Cancer Survivors - psychology</topic><topic>Cancer therapies</topic><topic>Confidence intervals</topic><topic>Coping strategies</topic><topic>Cost Savings</topic><topic>cost-coping strategies</topic><topic>cost-related medication nonadherence</topic><topic>Deductibles and Coinsurance - economics</topic><topic>Drug Substitution - economics</topic><topic>Drugs, Generic - economics</topic><topic>Drugs, Generic - therapeutic use</topic><topic>Female</topic><topic>Health care expenditures</topic><topic>Health Care Surveys</topic><topic>Health Expenditures</topic><topic>Health insurance</topic><topic>Health Knowledge, Attitudes, Practice</topic><topic>health saving accounts</topic><topic>Health savings accounts</topic><topic>high-deductible health plan</topic><topic>Humans</topic><topic>Insurance coverage</topic><topic>Insurance Coverage - economics</topic><topic>Insurance, Health - economics</topic><topic>Male</topic><topic>Medical Savings Accounts</topic><topic>Medication Adherence</topic><topic>medications</topic><topic>Middle Aged</topic><topic>Money</topic><topic>National Health Interview Survey</topic><topic>Neoplasms - drug therapy</topic><topic>Neoplasms - economics</topic><topic>Neoplasms - epidemiology</topic><topic>Neoplasms - psychology</topic><topic>out-of-pocket costs</topic><topic>Patient compliance</topic><topic>Prescription drugs</topic><topic>Prone</topic><topic>Savings accounts</topic><topic>Survivor</topic><topic>Time Factors</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhao, Jingxuan</creatorcontrib><creatorcontrib>Zheng, Zhiyuan</creatorcontrib><creatorcontrib>Han, Xuesong</creatorcontrib><creatorcontrib>Davidoff, Amy J.</creatorcontrib><creatorcontrib>Banegas, Matthew P.</creatorcontrib><creatorcontrib>Rai, Ashish</creatorcontrib><creatorcontrib>Jemal, Ahmedin</creatorcontrib><creatorcontrib>Yabroff, K. Robin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><jtitle>Value in health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhao, Jingxuan</au><au>Zheng, Zhiyuan</au><au>Han, Xuesong</au><au>Davidoff, Amy J.</au><au>Banegas, Matthew P.</au><au>Rai, Ashish</au><au>Jemal, Ahmedin</au><au>Yabroff, K. Robin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cancer History, Health Insurance Coverage, and Cost-Related Medication Nonadherence and Medication Cost-Coping Strategies in the United States</atitle><jtitle>Value in health</jtitle><addtitle>Value Health</addtitle><date>2019-07</date><risdate>2019</risdate><volume>22</volume><issue>7</issue><spage>762</spage><epage>767</epage><pages>762-767</pages><issn>1098-3015</issn><eissn>1524-4733</eissn><abstract>To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage.
We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking less, or delaying medication because of cost, and (2) cost-coping strategies, measured as requesting lower cost medication or using alternative therapies to save money. Separate multivariable logistic regressions were used to calculate the adjusted odds ratios (AORs) of CRN and cost-coping strategies associated with cancer history, stratified by insurance.
Cancer survivors were more likely than adults without a cancer history to report CRN (AOR 1.26; 95% confidence interval [CI] 1.10-1.43) and cost-coping strategies (AOR 1.10; 95% CI 0.99-1.19). Among the privately insured, the difference in CRN by cancer history was the greatest among those enrolled in high-deductible health plans (HDHPs) without health savings accounts (HSAs) (AOR 1.78; 95% CI 1.30-2.44). Among adults with HDHP and HSA, cancer survivors were less likely to report cost-coping strategies (AOR 0.62; 95% CI 0.42-0.90). Regardless of cancer history, CRN and cost-coping strategies were the highest for those uninsured, enrolled in HDHP without HSA, and without prescription drug coverage under their health plan (all P<.001).
Cancer survivors are prone to CRN and more likely to use cost-coping strategies. Expanding options for health insurance coverage, use of HSAs for those with HDHP, and enhanced prescription drug coverage may effectively address CRN.
•Policy makers, healthcare providers, and patients are increasingly concerned about rising out-of-pocket costs for prescription drugs and cost-related medication nonadherence (CRN). Previous studies have demonstrated that cancer survivors are more likely than adults without a cancer history to experience high out-of-pocket costs and medical financial hardship.•In this study, we used the most recent nationally representative data to evaluate the complex relationship between cancer history, health insurance coverage, and cost-related changes in medication use, including both CRN and cost-coping strategies among individuals aged 18 to 64 years.•We found that cancer survivors were more likely to report CRN than were similar individuals without a cancer history. Intervention strategies to address CRN may be warranted for cancer survivors. Regardless of cancer history, CRN and cost-coping strategies were the highest for the uninsured, those with high-deductible health plans without health savings accounts, or those without prescription drug coverage under their health plan. Expanding options for health insurance coverage, use of health savings accounts for those with high-deductible health plans, and enhanced prescription drug coverage among the insured may be effective strategies to address CRN.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31277821</pmid><doi>10.1016/j.jval.2019.01.015</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Value in health, 2019-07, Vol.22 (7), p.762-767 |
| issn | 1098-3015 1524-4733 |
| language | eng |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; Elsevier ScienceDirect Journals Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Adolescent Adult Adults Alternative medicine Antineoplastic Agents - economics Antineoplastic Agents - therapeutic use Cancer Cancer Survivors - psychology Cancer therapies Confidence intervals Coping strategies Cost Savings cost-coping strategies cost-related medication nonadherence Deductibles and Coinsurance - economics Drug Substitution - economics Drugs, Generic - economics Drugs, Generic - therapeutic use Female Health care expenditures Health Care Surveys Health Expenditures Health insurance Health Knowledge, Attitudes, Practice health saving accounts Health savings accounts high-deductible health plan Humans Insurance coverage Insurance Coverage - economics Insurance, Health - economics Male Medical Savings Accounts Medication Adherence medications Middle Aged Money National Health Interview Survey Neoplasms - drug therapy Neoplasms - economics Neoplasms - epidemiology Neoplasms - psychology out-of-pocket costs Patient compliance Prescription drugs Prone Savings accounts Survivor Time Factors United States - epidemiology Young Adult |
| title | Cancer History, Health Insurance Coverage, and Cost-Related Medication Nonadherence and Medication Cost-Coping Strategies in the United States |
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