University of Tennessee Health Science Center College of Pharmacy, Memphis.
University of South Carolina College of Pharmacy, Columbia.
J Manag Care Spec Pharm. 2020 Nov;26(11):1477-1486. doi: 10.18553/jmcp.2020.26.11.1477.
Because of increasing safety concerns related to erythropoiesisstimulating agents (ESAs), the Centers for Medicare & Medicaid Services issued a Medicare reimbursement policy change regarding these medications in cancer patients. However, the policy established an absolute hemoglobin or hematocrit threshold to qualify for reasonable use but did not take the effect of gender and racial/ethnic differences in hemoglobin levels into consideration. To examine disparities in the use of ESAs and blood transfusions after the Medicare policy change. This study was an exploratory treatment effectiveness study and used the SEER-Medicare linked database. The treatment group was composed of cancer patients, whereas the control group was composed of chronic kidney disease patients. An interrupted time series design was used to examine the effect of the Medicare policy change on the use of ESAs and blood transfusions in different gender and racial/ethnic groups. The Medicare reimbursement policy change had an immediate effect on reducing the use of ESAs by 50% and increasing the use of blood transfusions by 10%. The immediate effect of the policy change on the monthly utilization of ESAs was 2 times greater in females (60% reduction) than males (30% reduction). Females had a 10% immediate increase in the monthly utilization of blood transfusions after the policy change. The policy change had the same immediate effect of a 50% reduction on the use of ESAs for Whites, African Americans/Blacks, and Latinos. African Americans/Blacks had a 50% immediate increase in the monthly utilization of blood transfusions after the policy change. Gender and racial/ethnic disparities were associated with the Medicare reimbursement policy change in the use of ESAs and blood transfusions. Thus, future policy considerations should keep biologic differences across gender and racial/ethnic groups in mind. This study was funded by the SPARC Research Grant. The funder had no role in any part of this study. The authors have nothing to disclose.
由于与红细胞生成刺激剂（ESAs）相关的安全性问题不断增加，医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）发布了一项针对癌症患者此类药物的医疗保险报销政策变更。然而，该政策为合理使用设定了一个绝对的血红蛋白或血细胞比容阈值，但没有考虑到性别和种族/民族差异对血红蛋白水平的影响。本研究旨在检查医疗保险政策变更后 ESA 和输血的使用差异。
本研究是一项探索性的治疗效果研究，使用了 SEER-Medicare 关联数据库。治疗组由癌症患者组成，对照组由慢性肾脏病患者组成。采用中断时间序列设计来检验医疗保险政策变更对不同性别和种族/民族群体中 ESA 和输血使用的影响。
医疗保险报销政策变更立即产生了影响，使 ESA 的使用减少了 50%，输血的使用增加了 10%。政策变更对女性（减少 60%）每月 ESA 使用率的即时影响是男性（减少 30%）的两倍。政策变更后，女性每月输血的使用率立即增加了 10%。对于白人、非裔美国人/黑人以及拉丁裔，政策变更对 ESA 使用的即时影响相同，均可减少 50%。政策变更后，非裔美国人/黑人每月输血的使用率立即增加了 50%。
性别和种族/民族差异与医疗保险报销政策变更对 ESA 和输血的使用有关。因此，未来的政策考虑应考虑到性别和种族/民族群体之间的生物学差异。本研究由 SPARC 研究资助。资助者在本研究的任何部分都没有作用。作者没有要披露的内容。
