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Associations between rehabilitation utilization and out-of-pocket costs among older adults with breast cancer in the United States
Journal article   Peer reviewed

Associations between rehabilitation utilization and out-of-pocket costs among older adults with breast cancer in the United States

Rachelle Brick, Courtney P. Williams, Luqin Deng, Michelle A. Mollica, Nicole Stout and Jessica Gorzelitz
Archives of physical medicine and rehabilitation, Vol.105(12), pp.2301-2308
12/2024
DOI: 10.1016/j.apmr.2024.08.002
PMCID: PMC11620952
PMID: 39173732
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC11620952/pdf/nihms-2019977.pdfView
Open Access

Abstract

Objective: To examine the association between rehabilitation utilization within 12 months of breast cancer diagnosis and out-of-pocket costs in the second year (12 – 24 months following diagnosis). Design: Secondary analysis of the 2009-2019 Surveillance, Epidemiology and End Results-Medicare linked database. Individuals who received rehabilitation services were propensity-score matched to individuals who did not receive services. Overall and health care service-specific models were examined using generalized linear models with a gamma distribution. Setting: Inpatient and outpatient medical facilities in the United States Participants: 35,212 individuals diagnosed with non-metastatic breast cancer and were continuously enrolled in Medicare Fee-For Service (parts A, B, and D) in the 12 months prior to and 24 months post- diagnosis. Intervention: Not applicable Main Outcome Measures: Individual cost responsibility, a proxy for out-of-pocket costs, which was defined as deductibles, coinsurance, and copayments during the second year following diagnosis (12 – 24 months post- diagnosis). Results: The mean individual cost responsibility was higher in individuals who utilized rehabilitation compared to those who did not ($4,013 vs. $3,783), although it was not a clinically meaningful difference (d=0.06). Individuals who received rehabilitative services had significantly higher costs attributed to individual provider care ($1,634 vs. $1,476), institutional outpatient costs ($886 vs. $812), and prescription drugs ($959 vs. $906), and significantly lower costs attributed to institutional inpatient costs ($455 vs. $504), and durable medical equipment ($81 vs. $86). Conclusions: Older adults with breast cancer who received rehabilitation services had higher cost responsibility during the second year following diagnosis compared to those who did not. Future work is needed to examine the relationship between rehabilitation and out-of-pocket costs across longer periods of time and in conjunction with perceived benefit.
Breast Cancer health expenditures rehabilitation survivorship

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