医疗保险受益人群癌症患者支持性护理药物的使用和支出。
Use of and spending on supportive care medications among Medicare beneficiaries with cancer.
出版信息
Support Care Cancer. 2014 Aug;22(8):2185-95. doi: 10.1007/s00520-014-2187-2.
PURPOSE
The study objective was to provide population-based estimates of supportive care medication (SCM) use among Medicare beneficiaries with cancer and determine factors related to SCM receipt.
METHODS
This retrospective cohort study of community-based Medicare beneficiaries used the Medicare Current Beneficiary Survey (1997–2007). Dependent variables comprised use and spending on SCMs for three medication classes: opioids, antidepressants/sedative/hypnotics (ASH), and antiemetics. Independent variables of interest were supplemental insurance coverage, cancer site, and treatment. Multivariate models determined factors affecting receipt of, and spending on, SCMs. We also compared SCM use and spending among beneficiaries with and without cancer in order to understand what portion of SCM use and spending could be attributed to cancer as opposed to other comorbid conditions.
RESULTS
A total of 1,836 Medicare beneficiaries with cancer and 9,898 beneficiaries without cancer were eligible for the study. Beneficiaries with cancer were more likely to receive opioids, ASH, and antiemetics compared to non-cancer beneficiaries. Adjusted annual payments for antiemetics were on average $637 higher in with cancer versus without cancer (p<0.01), while ASH payments were $184 lower (p<0.01). Opioid spending was similar among cancer and non-cancer users. Relative to colon cancer, beneficiaries with prostate cancer were least likely to receive any of the three SCM classes. Receipt of antineoplastic treatment increased the probability of use of all three classes of SCMs. Insurance coverage did not influence the use of or spending on opioids or antiemetics, but was associated with both outcomes for ASH. The use of all three SCM classes was significantly lower during years before Part D implementation of the new Medicare Part D prescription drug benefit and was higher after implementation of Part D.
CONCLUSION
This study provides population-based information on SCM use among Medicare beneficiaries with cancer. Cancer site and treatment modality were important predictors of SCM use.
目的
本研究旨在提供基于人群的癌症医疗保险受益人群支持性护理药物（SCM）使用情况数据，并确定与 SCM 使用相关的因素。
方法
本研究采用基于社区的医疗保险受益人群的回顾性队列研究方法，利用 Medicare 现行受益调查（1997-2007 年）数据。因变量包括三类 SCM（阿片类药物、抗抑郁药/镇静催眠药（ASH）和止吐药）的使用情况和花费。感兴趣的自变量包括补充保险覆盖范围、癌症部位和治疗方法。多变量模型确定影响 SCM 使用和花费的因素。我们还比较了癌症患者和非癌症患者的 SCM 使用和花费，以了解 SCM 使用和花费中有多少可以归因于癌症，而不是其他合并症。
结果
共有 1836 名癌症医疗保险受益人和 9898 名非癌症医疗保险受益人符合研究条件。与非癌症受益人群相比，癌症受益人群更有可能使用阿片类药物、ASH 和止吐药。与无癌症患者相比，癌症患者的止吐药年平均支出高出 637 美元（p<0.01），而 ASH 支出则低 184 美元（p<0.01）。癌症和非癌症使用者的阿片类药物支出相似。与结肠癌相比，前列腺癌患者接受三种 SCM 类药物的可能性最小。接受抗肿瘤治疗可增加使用三种 SCM 类药物的概率。保险覆盖对阿片类药物或止吐药的使用或支出没有影响，但与 ASH 的这两个结果都有关。在新医疗保险处方药福利的 Medicare 部分 D 实施之前的几年中，所有三种 SCM 类药物的使用明显较低，在实施部分 D 之后则更高。
结论
本研究提供了基于人群的癌症医疗保险受益人群 SCM 使用情况信息。癌症部位和治疗方式是 SCM 使用的重要预测因素。
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