For a study, researchers sought to assess the association between insurance status and clinical and financial outcomes and financial toxicity (FT) risk among inpatients receiving gynecologic cancer resections. They located adult hospitalizations for hysterectomy or oophorectomy with a cancer diagnosis using the 2008–2019 National Inpatient Sample. The impact of insurance status was evaluated for hospitalization expenses, length of stay (LOS), mortality, and complications. Health expenses greater than 40% of post-subsistence income were used to define the risk of FT. Regressions with several variables were used to examine FT risk costs and contributing factors. About 49.4% of 462,529 patients had government-funded insurance, 44.3% had private insurance, and 3.2% had no insurance. Uninsured individuals were more likely to be Black and Hispanic, be admitted urgently, and have open surgeries than insured patients. Patients without insurance had comparable mortality but higher rates of complications, LOS, and expenses. Comparing ovarian cancer resections to cervical and uterine cancer resections, the median cost for ovarian cancer resections was $17,258 (interquartile range: $12,187-25,491). Patients at risk for FT included 15.4% of insured patients and 52.8% of uninsured patients. Over the course of the 12-year study period, expenses rose for both cohorts, widening the FT risk gap according to payer status. Perioperative problems were linked to a nearly 2-fold higher incidence of FT among those without insurance after risk adjustment (adjusted odds ratio 1.75, 95% CI 1.46-2.09, P<0.001). Black and Hispanic ethnicity, public insurance, and an open-operative approach showed higher odds of FT among the insured. Gynecologic cancer patients are significantly more likely to experience FT during surgery, especially uninsured patients. To reduce the financial load, targeted cost-mitigation methods were required.

Source: sciencedirect.com/science/article/pii/S0090825822003286