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乳腺癌激素治疗的费用分担:双重资格患者的共付额如何影响依从性。

Cost sharing for breast cancer hormone therapy: How do dual eligible patients' copayment impact adherence.

机构信息

The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States of America.

Tufts Medical Center, Tufts University, Boston, MA, United States of America.

出版信息

PLoS One. 2021 May 18;16(5):e0250967. doi: 10.1371/journal.pone.0250967. eCollection 2021.

Abstract

OBJECTIVE

To examine the different levels of copayment assistance and treatment adherence among Medicare and Medicaid dual eligible beneficiaries with breast cancer in the U.S.

RESEARCH DESIGN

Propensity Score methodology was adopted to minimize potential selection bias from the nonrandom allocation of the treatment group (i.e., full Medicaid beneficiaries) and control group (i.e., Medicare Savings Programs [MSPs] beneficiaries). Longitudinal hierarchical model and Cox proportional-hazard model were adopted to examine patients' adherence over their full five-year course of adjuvant hormone therapy.

RESULTS

Our study cohort consisted of 1,133 dual eligible beneficiaries diagnosed with hormone receptor-positive early stage breast cancer in years 2007 -mid 2009. About 80.5% of them received MSPs benefits, while the rest received full Medicaid benefits. On average for a standardized 30-day hormone therapy medication, full Medicaid beneficiaries spent $0.5-$2.0 and MSP beneficiaries spent $1.4-$4.8 in copayment. After adjusting for other factors, this copayment reduction wasn't associated with a significantly better adherence. However, when the catastrophic coverage threshold was reached (copayments reduced to zero), significant improvement in adherence was found in both groups.

CONCLUSIONS

Our study found that small amount of cost-sharing reduction did not affect Medicare and Medicaid dual eligible patients' medication treatment adherence, however, the elimination of cost-sharing (even a minimal amount) was associated with improved adherence. Future legislative and advocacy efforts should be paid on eliminating cost sharing for dual eligibles, and possibly even a broader group of financially vulnerable patients.

摘要

目的

考察美国医疗保险和医疗补助双重合格的乳腺癌受益人的不同共付额援助水平和治疗依从性。

研究设计

采用倾向评分方法,以尽量减少治疗组(即全额医疗补助受益人)和对照组(即医疗保险储蓄计划 [MSP] 受益人)非随机分配的潜在选择偏差。采用纵向分层模型和 Cox 比例风险模型来检查患者在整个五年辅助激素治疗过程中的依从性。

结果

我们的研究队列包括 1133 名在 2007 年至 2009 年中期被诊断患有激素受体阳性早期乳腺癌的双重合格受益人。其中约 80.5%的人接受了 MSP 福利,其余的人则接受了全额医疗补助福利。对于标准化的 30 天激素治疗药物,全额医疗补助受益人的共付额为 0.5-2.0 美元,而 MSP 受益人的共付额为 1.4-4.8 美元。在调整其他因素后,这种共付额减少与明显更好的依从性无关。然而,当达到灾难性保险覆盖阈值时(共付额降低到零),两组的依从性都显著提高。

结论

我们的研究发现,少量的成本分担减少并没有影响医疗保险和医疗补助双重合格患者的药物治疗依从性,然而,消除成本分担(即使是少量的)与提高依从性有关。未来的立法和宣传工作应关注消除双重合格患者的成本分担,甚至可能是更广泛的经济脆弱患者群体。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b0ee/8130966/2568852b6eed/pone.0250967.g001.jpg

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