Health plans

High-deductible health plans linked to delays in detecting metastatic cancer


Trad NK, et al. Abstract 6503. Presented to: ASCO Annual Meeting; June 3-7, 2022; Chicago.

Disclosures: Trad does not report any relevant financial information. Please see the summary for all relevant financial disclosures from other researchers.

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CHICAGO — According to the results of an observational study presented at the ASCO annual meeting, patients on high-deductible health plans experienced delays in detecting metastatic cancer.

“Specifically, we observed a delay in cancer diagnosis of 4.6 months,” Nicolas Karim Trad, BA, medical student at Harvard Medical School, said during his presentation.

Estimation of time to diagnosis of cancer.
Data taken from Trad NK, et al. Abstract 6503. Presented to: ASCO Annual Meeting; June 3-7, 2022; Chicago.

Rationale and methods

Trad and colleagues examined the impact of high-deductible health plans on the timing of metastatic cancer detection in 345,401 people (mean age, 42 years; 49% female) with high-deductible health plans by compared to 1,654,775 people (mean age, 42; 50% women) with low-deductible plans. It should be noted that both groups had a one-year qualifying period when all members were enrolled in low-deductible plans.

Researchers matched study participants based on age, gender, race/ethnicity, and morbidity score (ACG), as well as level of poverty, geographic region, family size, employer, basic primary cancer, basic medical and pharmaceutical costs and length of follow-up. The high-deductible and low-deductible cohorts had an average ACG score of 1.4.

The researchers used a validated claims-based algorithm to detect diagnoses of incident metastatic cancer and assessed time to diagnosis during baseline and follow-up using Cox’s weighted proportional hazards model.

Follow-up was a maximum of 13.5 years.

Main conclusions

The researchers observed no difference in time to metastatic diagnosis at baseline (HR = 0.96). However, people with a high-deductible health insurance plan experienced a longer time to first diagnosis of metastatic cancer (HR = 0.88; P = 0.01), indicating a delay in cancer detection compared to the control group.

Look forward

Nicolas Karim Trad, BA

Nicolas Karim Trad

“Potential impacts of late cancer diagnosis include delayed initiation of palliative care and symptom-relieving therapies, as well as greater disease spread, which further limits treatment options,” Trad said. “There were potential limitations to our study, including that our data was claim-based and that there was potential for unbalanced and unmeasured confounders. For the future, we need innovative health insurance models.

These models should reduce the cost-sharing burden on patients so they are not deterred from seeking care and should align with, rather than contradict, the goal of improving cancer survival, said he added.

For more information:

Nicolas KarimTrad, BA, can be contacted at