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Sun Life annual report on high-cost medical claims shows cancer continued to increase in cost and frequency despite pandemic

Press releases may be edited for formatting or style | June 02, 2021

"Mental health is health," added Collier. "Often the symptoms and signs are harder to detect, even in the people we see or talk to every day. We encourage our clients to continue focusing on workplace mental health, which will foster positive impacts to their employees' overall health and well-being."

Other key takeaways from Sun Life's report include:

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COVID-19 cost factors

The highest COVID-19 claim was $3 million.
Contributing factors that drove COVID-19 claims costs included long inpatient stays, duration of treatment, extensive diagnostics, cost of medication, complications, comorbidities and continued care.
The relatively small number of COVID-19 cases that were severe enough to result in a stop-loss claim averaged approximately $340,000 per patient, with infection and respiratory failure as the most common comorbidities contributing to high costs.
Other COVID-19 comorbidities that generated high costs in 2020 were acute renal failure, encephalopathy (brain damage), pneumonia, and cardiac dysrhythmia (abnormal heartbeat).
Cancer trends

In 2020, members with a cancer claim increased by 16.1%; members with prostate, colon, or breast rose by 27%, 19% and 12% respectively.
Experts predict there may be a significant increase in the coming years in cancer diagnoses and cancer-related deaths due to missed screenings and delayed diagnoses during 2020.
Specialty drug costs

Nine out of the top 10 costliest injectable drugs are used to treat cancer, with average costs per patient ranging from about $40,000 to $174,500.
The two drugs with the highest average costs are Soliris and Ultomiris, used to treat blood disorders, with an annual average per person cost of about $420,100 and $492,900 respectively.
Postponed clinical trials during the pandemic may result in delayed approvals and fewer new drugs in 2021.
Million-dollar claims

Million-dollar+ claims increased 9% from 2019 to 2020.
The highest medical claim in 2020 was for cancer, totaling $6.3 million.
The most frequent $3 million-dollar+ conditions in 2020 included cancer, birth conditions, COVID-19 and pulmonary collapse.
There is no single driver of million-dollar claims; most are driven by some combination of complicated procedures, high-cost drugs, advanced life-sustaining treatments, and long in-patient hospitalizations, regardless of diagnosis.
Other pandemic impacts

Costs for transplants actually decreased from an average of approximately $303,000 per patient in 2019 to $140,000 in 2020, which could be a result of:

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