Comparison of Out-of-Pocket Costs for Patients (pts) with Hodgkin’s Disease (HD), Indolent Non-Hodgkin’s Lymphoma (INHL) and Aggressive Non-Hodgkin’s Lymphoma (ANHL).
Authors: McCaffrey Kathryn , Fisher Matthew , Kutikova Lucie , Bowman Lee , Evens Andrew , Gordon Leo , Auto Heather , Bennett Charles 
Published: October 2019

Abstract
Background We report preliminary results from an ongoing study on the out-of-pocket costs (costs incurred by a pt as a result of treatment and illness of cancer that are not covered by healthcare insurance) for a cohort of lymphoma pts. How out-of-pocket costs vary according to demographics such as household income and education were reported previously. Herein, we explore two clinical factors that may influence out-of-pocket costs. We compare costs for HD, INHL and ANHL by time since diagnosis (Dx) and treatment type (with or without rituximab) for NHL.
Methods Lymphoma pts provided information on out-of-pocket costs for 3-month periods before and after lymphoma Dx. Difference between these costs was calculated. From current sample of 56 pts, 4 outliers with high costs preceding lymphoma Dx were excluded. Direct medical costs are costs related to medical care such as medications, procedures and doctor visits. Direct non-medical costs are peripheral costs related to cancer such as costs for meals, transportation, childcare, and phone calls. Dx date and treatment data were abstracted from pt medical charts.
Results The majority of lymphoma pts were < 65 years old (76%), married (65%), and employed (58%). All pts were undergoing active treatment and had healthcare insurance coverage, with the majority insured with private plans (81%). 21% of pts were relapse pts; 25% of pts had stage I–II lymphoma, 44% had stage III–IV, and 31% had unknown stage. Median monthly total out-of-pocket costs for all lymphoma types were $374. Direct medical costs for HD pts were 1.9 and 1.1-fold higher than for INHL and ANHL pts, respectively. Direct non-medical costs were highest for ANHL. Total costs for NHL pts ≤ 3 months since Dx were 3.3-fold higher than for pts > 3 months since Dx, which was consistent by NHL subtype. Total costs for NHL pts undergoing treatment without rituximab were 3.5-fold higher than costs for pts with rituximab.
Conclusion The median monthly out-of-pocket costs were greatest for HD ($457), followed by ANHL ($434) and INHL ($247), and were primarily driven by costs related to medical care. For NHL pts, factors associated with high costs included ≤ 3 months since Dx ($681) and treatment without rituximab ($813). It is important to consider the costs to individual pts to ensure more comprehensive economic analyses of cancer.
Median Monthly Out-of-Pocket Costs N Direct Medical Cost $ (range) Direct Non-Medical Cost $ (range) Total Cost $ (range) *Dx date not confirmed for 1 NHL pt All Pts 52 271 (−67–3545) 50 (−56–850) 374 (0–3775) HD 15 311 (−67–3203) 27 (−56–410) 457 (0–3365)     ≤ 3 months since Dx 5 308 (−67–2033) 20 (−56–175) 328 (67–2048)     > 3 months since Dx 10 372 (0–3203) 94 (0–410) 561 (0–3365) NHL 37 225 (−33–3545) 50 (0–850) 286 (10–3775)     INHL 17 145 (−33–1928) 40 (0–850) 247 (10–2043)     ANHL 20 283 (−32–3545) 111 (0–600) 434 (30–3775)     + Rituximab 29 145 (−33–3545) 45 (0–600) 232 (10–3775)     − Rituximab 8 549 (100–850) 138 (28–850) 813 (137–1700)     ≤ 3 months since Dx 12 458 (42–3545) 108 (0–383) 681 (42–3775)     > 3 months since Dx 24* 141 (−33–2650) 42 (0–850)208 (10–3250)