Health care cost trajectories among patients with cancer and cardiometabolic comorbidities over a decade including the pandemic period.

Abstract

Cardiometabolic comorbidities, including hypertension, hyperlipidemia, and diabetes, are common among patients with cancer. Although the financial burden of cancer is well documented, how the extent to which these comorbidities affect trends in health care costs after a cancer diagnosis remains unknown. Furthermore, the influence of the COVID-19 pandemic on these health care cost trends has yet to be thoroughly examined. To assess trends in annual health care costs among patients with cancer over a decade, including the pandemic period, and the impact of preexisting cardiometabolic comorbidities on these costs. This retrospective cohort study used 2011-2021 MarketScan data to identify patients with newly diagnosed cancer annually from 2012 to 2020. The 2019 and 2020 cohorts included patients assessed during the COVID-19 pandemic. The primary predictor was the presence of preexisting comorbidities, including hypertension, hyperlipidemia, and diabetes, in the year before the cancer diagnosis. Outcomes were health care costs incurred within 1 year after the diagnosis, including inpatient, emergency department, outpatient, and pharmacy expenses. Generalized linear models and Joinpoint models estimated mean cost ratios and annual percentage changes (APCs). All costs were inflation-adjusted to 2021 US dollars. Among 738,414 patients (mean age: 60.5 years, SD: 13.2), 42.4% had hypertension, 41.5% hyperlipidemia, 14.9% diabetes, and 41.2% none of these comorbidities. From the 2012 cohort to the 2018 cohort, average health care costs during the first year after diagnosis increased steadily: from $30,702 to $41,962 (APC: 5.5%) for patients with hypertension, from $29,353 to $40,510 (APC: 5.6%) for hyperlipidemia, and from $28,968 to $42,432 (APC: 6.2%) for diabetes. Among those without these conditions, costs increased from $26,856 to $36,624 (APC: 5.1%), $28,188 to $38,259 (APC: 5.1%), and $28,608 to $38,620 (APC: 5.2%), respectively. Annual health care costs declined in the 2019 and 2020 cohorts, overlapping with the pandemic. Specifically, health care costs dropped to $30,992 (APC: -14.3%) for patients with hypertension, $29,332 (APC: -14.7%) for hyperlipidemia, and $31,301 (APC: -13.3%) for diabetes; corresponding declines were $26,003 (APC: -14.1%), $28,013 (APC: -13.6%), and $27,987 (APC: -14.5%) among patients without these conditions. Patients with hypertension, hyperlipidemia, and diabetes had 14% to 21%, 4% to 8%, and 1% to 12% higher annual health care costs, respectively, than those without these comorbidities. Health care costs for patients with cancer and preexisting cardiometabolic comorbidities have increased significantly since 2012, with a temporary decline after 2019, potentially due to the COVID-19 pandemic. Patients with cancer who had cardiometabolic comorbidities had significantly higher costs than those without these conditions.