Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis.
Department of Epidemiology and Biostatistics, University of South Carolina, Columbia.
J Manag Care Spec Pharm. 2021 Aug;27(8):1142-1152. doi: 10.18553/jmcp.2021.27.8.1142.
Before 2007, erythropoiesis-stimulating agents (ESAs) were the highest-expenditure drug in the Medicare system. In 2007, CMS issued a reimbursement policy change for ESAs used by cancer patients. However, empirical evidence is currently lacking to evaluate medical costs after the policy change, especially by sex and racial/ethnic groups. To examine the impact of the Medicare reimbursement policy change and associated racial/ethnic and sex disparities on medical costs for cancer patients who were new users of ESAs. This study was an exploratory retrospective treatment effectiveness study, which used SEER-Medicare linked data. A difference-in-difference design was used that incorporated a control group of patients with chronic kidney disease. A generalized linear model, with a log link and a gamma distribution, was used to examine medical costs. The Medicare reimbursement policy change was statistically significantly associated with an 11% (95% CI = 2%-20%) reduction in anemia-related costs, including a 10% (95% CI = 1%-19%) reduction in Medicare payment and an 18% (95% CI = 10%-26%) reduction in patient cost sharing. For total medical costs, the policy change was statistically significantly associated with a 12% (95% CI = 6%-18%) reduction, including an 11% (95% CI = 5%-18%) reduction in Medicare payment and a 14% (95% CI = 7%-20%) reduction in patient cost sharing. Medical costs were reduced in patients who were male and those who were White but remained the same for patients who were female and those who were Black, Hispanic, and other races or ethnicities. Anemia-related and total medical costs associated with ESAs used by cancer patients with chemotherapy-induced anemia were reduced after the Medicare reimbursement policy change. However, the policy change was only effective for patients who were male and those who were White. The policy change had no effect on patients who were female and those of racial/ethnic minorities. This study was funded by the SPARC Research Grant. The funder had no role in any part of this study. This study used the linked SEER-Medicare database. The interpretation and reporting of the data are the sole responsibility of the authors. The authors have nothing to disclose.
在 2007 年之前，红细胞生成刺激剂 (ESAs) 是医疗保险系统中支出最高的药物。2007 年，CMS 发布了一项针对癌症患者使用 ESA 的报销政策变更。然而，目前缺乏评估政策变更后医疗成本的经验证据，尤其是按性别和种族/族裔群体划分的情况。本研究旨在评估医疗保险报销政策变更以及相关的种族/族裔和性别差异对新使用 ESA 的癌症患者医疗成本的影响。
本研究是一项探索性的回顾性治疗效果研究，使用了 SEER-Medicare 关联数据。采用了一种差异-差异设计，纳入了慢性肾脏病患者作为对照组。使用对数链接和伽马分布的广义线性模型来检验医疗成本。医疗保险报销政策变更与贫血相关成本降低 11%（95%CI=2%-20%）具有统计学意义，其中医疗保险支付降低 10%（95%CI=1%-19%），患者自付费用降低 18%（95%CI=10%-26%）。对于总医疗费用，政策变更与降低 12%（95%CI=6%-18%）具有统计学意义，其中医疗保险支付降低 11%（95%CI=5%-18%），患者自付费用降低 14%（95%CI=7%-20%）。对于男性和白人患者，医疗费用降低，但对于女性和黑人、西班牙裔以及其他种族或族裔患者，医疗费用没有变化。
医疗保险报销政策变更后，化疗引起贫血的癌症患者使用 ESA 相关的贫血相关和总医疗费用降低。然而，该政策变更仅对男性和白人患者有效，对女性和少数民族患者没有影响。本研究由 SPARC 研究基金资助。资助者在本研究的任何部分都没有角色。本研究使用了 SEER-Medicare 关联数据库。作者对数据的解释和报告负全部责任。作者没有任何要披露的内容。
