Abstract
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.