Out of Pocket Costs for Patients Undergoing Thyroid Surgery.

OBJECTIVE: To determine out of pocket costs (OOPC) in patients undergoing thyroidectomy for benign and malignant conditions in a commercially insured US population.

SUMMARY BACKGROUND DATA: Little is known about OOPC for thyroid surgery in the United States.

METHODS: Retrospective cohort study using claims of patients undergoing thyroidectomy from the IBM Watson Marketscan database from 2008 to 2017. Out of pocket costs accrued from 90 days prior to surgery to 360 days after thyroid surgery were quantified. Costs were divided into expenditures for inpatient care, outpatient care and outpatient drug costs and over three time periods: from 90 days preoperatively to 30 days post operatively, from 30 days post operatively to 90 days postoperatively, and from 90 days to 1 year after surgery.

RESULTS: A total of 45,971 commercially insured patients aged 18-95 who underwent thyroidectomy were identified after excluding patients who changed coverage and patients on capitated plans. The median OOPC per patient in the study period of 90 days prior to surgery to 360 days after surgery was $2,434 (IQR $1,273 - $4,226), the median insurance reimbursement was $15,520 (IQR $7,653 - $29,149). Patients undergoing thyroidectomy for malignant conditions had a median OOPC of $3,019 (IQR $1,596 to $5,021) compared to $2,271 (IQR $1,201 to 3,954) for benign conditions (P<0.0001).Patients with PPO coverage had a median OOPC of $2,624 (IQR $1,458 to $4,358) compared to HMO patients with a median OOPC of $1,529 (IQR $739 to 3,058), and high deductible health plans with a median OOPC of $4,265 (IQR $2,788 to $6,210) (P<0.0001).

CONCLUSION: Despite commercial insurance coverage, patients face substantial out of pocket costs in the surgical management of thyroid disease in the United States.