The optimal adjuvant therapy (anti-estrogen therapy (ET) + radiotherapy or ET alone, or in some reports radiotherapy alone) in older women with early-stage breast cancer has been highly debated. However, granular details on the role of insurance in the out-of-pocket cost for patients receiving ET with or without radiotherapy are lacking. This project disaggregates out-of-pocket costs by insurance plans to increase treatment cost transparency. Several radiotherapy schedules are accepted standards as per the National Comprehensive Cancer Network guidelines. For our financial estimate model, we utilized the five-fraction and fifteen-fraction radiotherapy, and ET prescribed over a five-year duration. The total aggregate out-of-pocket costs were determined from the sum of treatment costs, deductibles, and copays/coinsurance based on Medicaid, Original Medicare, Medigap Plan G, and Medicare Part D Rx plans. The model assumes a Medicare- and/or Medicaid-eligible patient ≥ 70 years of age with node-negative, early-stage estrogen-receptor-positive breast cancer. Patient out-of-pocket costs were estimated from publicly available insurance data from plan-specific benefit coverage materials using a five-year time horizon. Original Medicare beneficiaries face a total out-of-pocket treatment charge of $2,738.52 for ET alone, $2,221.26 for five-fraction radiotherapy alone, $2,573.92 for fifteen-fraction radiotherapy alone, $3,361.26 for combined ET+ five-fraction radiotherapy, and $3,713.92 for combined ET + fifteen-fraction radiotherapy. Medigap Plan G beneficiaries have an out-of-pocket charge of $1,130.00 with radiotherapy alone and face an out-of-pocket of $2,270.00 for ET alone and combined ET+radiotherapy. For Medicaid beneficiaries - all treatments approved by Medicaid - are covered without limit, resulting in no out-of-pocket expense for either adjuvant treatment option. This model (based on actual cost estimates per insurance plan rather than claims data) by estimating expenses within Medicare and Medicaid plans provides a level of transparency to patient cost. With knowledge of the costs borne by patients themselves, treatment decisions informed by patients’ individual priorities and preferences may be further enhanced.

中文翻译：

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医疗补助和医疗保险计划中早期乳腺癌肿瘤切除术后辅助抗雌激素和放射治疗的自付费用模型

对于患有早期乳腺癌的老年女性来说，最佳辅助治疗（抗雌激素治疗 (ET) + 放疗或单独 ET，或在一些报告中单独放疗）一直备受争议。然而，对于接受或不接受放疗的 ET 患者的自付费用，保险在自付费用中的作用尚缺乏详细信息。该项目通过保险计划对自付费用进行分类，以提高治疗成本的透明度。根据国家综合癌症网络指南，一些放射治疗计划已成为公认的标准。对于我们的财务估算模型，我们使用了五分式和十五分式放射治疗，以及为期五年的 ET 处方。自付费用总额是根据 Medicaid、Original Medicare、Medigap Plan G 和 Medicare Part D Rx 计划的治疗费用、免赔额和共付额/共同保险的总和确定的。该模型假设符合 Medicare 和/或 Medicaid 资格的患者年龄≥ 70 岁，患有淋巴结阴性、早期雌激素受体阳性乳腺癌。患者自付费用是根据五年时间范围内的计划特定福利承保材料中公开的保险数据进行估算的。原始 Medicare 受益人单独 ET 的自付费用总计为 2,738.52 美元，单独五次放疗的自付费用为 2,221.26 美元，单独十五次放疗的自付费用为 2,573.92 美元，ET+ 五次放疗联合治疗的自付费用为 3,361.26 美元，ET+ 联合放疗的自付费用为 3,713.92 美元。十五分次放射治疗。Medigap 计划 G 受益人仅接受放射治疗的自付费用为 1,130.00 美元，单独接受 ET 和联合接受 ET+放射治疗的自付费用为 2,270.00 美元。对于医疗补助受益人 - 医疗补助批准的所有治疗 - 均不受限制地承保，因此任何辅助治疗选项都无需自付费用。该模型（基于每个保险计划的实际成本估算而不是索赔数据）通过估算医疗保险和医疗补助计划内的费用，为患者成本提供了一定程度的透明度。了解患者自己承担的费用后，可以进一步加强根据患者个人优先事项和偏好做出的治疗决策。