Economics Department, Temple University, Philadelphia, Pennsylvania.
National Bureau of Economic Research, Cambridge, Massachussets.
Health Serv Res. 2020 Jun;55(3):399-410. doi: 10.1111/1475-6773.13289. Epub 2020 Apr 17.
To quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees.
DATA SOURCE/STUDY SETTING: Medicaid State Drug Utilization Database (SDUD) 2011-2018, comprising the universe of outpatient prescription medications covered under the Medicaid program.
Differences-in-differences and event-study linear models compare population rates of tamoxifen and aromatase inhibitor (anastrozole, exemestane, and letrozole) use in expansion and nonexpansion states, controlling for population characteristics, state, and time.
Relative to nonexpansion states, Medicaid-financed hormonal therapy prescriptions increased by 27.2 per 100 000 nonelderly women in a state. This implies a 28.8 percent increase from the pre-expansion mean of 94.2 per 100 000 nonelderly women in expansion states. The event-study model reveals no evidence of differential pretrends in expansion and nonexpansion states and suggests use grew to 40 or more prescriptions per 100 000 nonelderly women 3-5 years postexpansion.
Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer.
量化平价医疗法案（Affordable Care Act）扩大医疗补助计划（Medicaid expansion）对医疗补助计划参保者有效乳腺癌激素疗法（他莫昔芬和芳香化酶抑制剂）处方的影响。
数据来源/研究环境：2011 年至 2018 年 Medicaid 州药品使用数据库（Medicaid State Drug Utilization Database，SDUD），涵盖 Medicaid 计划涵盖的所有门诊处方药。
差异中的差异和事件研究线性模型比较了在扩张和非扩张州中，他莫昔芬和芳香化酶抑制剂（阿那曲唑、依西美坦和来曲唑）使用的人群率，同时控制了人口特征、州和时间。
相对于非扩张州，一个州中每 10 万名非老年女性的医疗补助资助激素疗法处方增加了 27.2 份。这意味着从扩张前的每 10 万名非老年女性 94.2 份增加了 28.8%。事件研究模型没有发现扩张和非扩张州之间存在预先趋势差异的证据，并表明在扩张后 3-5 年内，每 10 万名非老年女性的处方使用量增长到 40 份或更多。
医疗补助计划的扩张可能对低收入女性获得用于治疗乳腺癌的有效激素疗法的能力产生了有意义的影响。
