Financial burden within first year of diagnosis for privately-insured patients with early-onset breast or colorectal cancer.

9 Background: Rising incidence of early-onset (E-O) cancers has been observed globally. E-O breast cancer (BC) are patients (pts) diagnosed ages 18 to 44 and E-O colorectal cancer (CRC) are aged 18 to 49. Because many E-O cancers are among pts who do not meet screening eligibility criteria by age, they are often diagnosed at advanced stage, which is also more expensive to treat. Younger pts may also have lower incomes and fewer assets, increasing risk of financial burden for pts with E-O cancers. We estimated the financial burden for pts and private payors for E-O BC and CRC, compared to non-elderly pts with BC and CRC diagnosed between the age of 45 to 64 and 50 to 64 (older-onset), respectively. Methods: We applied a claims-based algorithm to identify pts with incident BC and CRC diagnosed between 2014 and 2021 from MarketScan Commercial Claims and Encounters Data and required 12-month continuous enrollment before and after the index diagnosis for completeness of claims. Financial burden was quantified as total and out-of-pocket (OOP) payments, calculated as the sum of deductibles, copayments, and coinsurance. We used generalized linear models and quantile regressions to compare differences in mean and median costs, respectively, between pts with E-O vs. older onset cancer, adjusting for comorbidity, region, insurance plan type, sex (for CRC) and year. Results: Study cohort included 58,419 pts with BC and 11,251 pts with CRC. The proportion of E-O increased from 15% in 2014 to 17% in 2022 (Ptrend<0.01) in BC and from 23% to 30% (Ptrend<0.01) in CRC. Higher percentage of E-O pts were enrolled in high-deductible plans (BC: 25% v22%; CRC: 24% vs. 21%) and received systemic therapy (BC: 61% v 49%; CRC: 57% vs. 43%). Higher percent of surgery (93% v 89%) was observed in E-O BC and radiation (21% v 16%) in E-O CRC. Pts with E-O BC and CRC had significantly higher adjusted mean and median total and OOP payments (Table). Conclusions: E-O BC and CRC result in substantial costs to payors and moderately higher OOP payments. OOP maximums in private insurance may offer some financial protection for pts. E-O Older onset Difference 95% CIBC: BC: Mean total pay $182,770 $128,640 $54,130 $50445, $57817 Median total pay 143,351 93,317 50,034 47691, 52377 Mean OOP 6,014 5,063 951 817, 1085 Median OOP 5,142 4,258 884 791, 978 CRC: Mean total pay $153,446 $123,449 $29,998 $24244, $35752 Median total pay 119,747 89,340 30,406 25216, 35597 Mean OOP 5,429 4,791 638 428, 848 Median OOP 4,452 4,015 437 266, 607