McDermott+ Consulting, Washington, DC.
Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, Virginia.
JAMA Netw Open. 2024 Sep 3;7(9):e2434707. doi: 10.1001/jamanetworkopen.2024.34707.
Medicare Advantage (MA) has grown significantly over the last decade; however, MA's performance for patients with serious conditions, such as cancer, remains unclear.
To compare resource use and care quality between MA and traditional Medicare (TM) beneficiaries undergoing cancer chemotherapy.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used TM claims and MA encounter records from January 2015 to December 2019. Participants were MA and TM beneficiaries who initiated cancer chemotherapy between January 2016 and December 2019. Inverse probability of treatment weighting balanced characteristics between MA and TM beneficiaries, and regression estimation was used. The analysis was conducted between August 2023 and May 2024.
Chemotherapy initiation after a 1-year washout period.
Resource use and care quality were measured during a 6-month period following chemotherapy initiation. Resource use was measured using standardized prices for services in both MA and TM, covering hospital inpatient services, outpatient care, Part D drugs, and hospice services. Chemotherapy utilization was examined for Part B chemotherapy, Part B supportive drugs, and Part D chemotherapy. Quality measures included chemotherapy-related emergency department (ED) visits and hospitalizations, avoidable ED visits, preventable hospitalizations during the 6-month episode, and survival days up to 18 months from chemotherapy initiation.
The study comprised 96 501 MA enrollees contributing to 98 872 episodes (mean [SD] age, 72.9 [7.6] years; 55 859 [56.5%] female; 7371 [7.5%] Hispanic, 14 778 [14.9%] non-Hispanic Black, and 75 130 [75.0%] non-Hispanic White participants) and 206 274 TM beneficiaries, contributing 212 969 episodes (mean [SD] age, 72.7 [8.3] years; 121 263 [56.9%] female; 8356 [3.9%] Hispanic, 16 693 [7.8%] non-Hispanic Black, and 182 228 [85.6%] non-Hispanic White participants). Adjusted total resource use per enrollee during the 6-month episode was $8718 (95% CI, $8343 to $9094) lower in MA than TM ($62 599 vs $71 317). Part B chemotherapy resource use accounted for most of the difference in total resource use, with MA enrollees having $5032 (95% CI, $4772 to $5293) lower use than TM beneficiaries. Lower resource use for Part B chemotherapy in MA was associated with both fewer chemotherapy visits (-1.06 visits; 95% CI, -1.10 to -1.02 visits) and less expensive chemotherapy per visit (-$277; 95% CI, -$275 to -$179). Findings on quality were mixed, but importantly, survival did not differ between MA and TM patients who initiated chemotherapy.
In this cohort study of Medicare beneficiaries with cancer undergoing chemotherapy, MA enrollment was associated with lower resource use but not shorter survival.
在过去十年中，医疗保险优势（MA）显著增长；然而，MA 对患有严重疾病（如癌症）的患者的表现仍不清楚。
比较癌症化疗患者中 MA 和传统医疗保险（TM）受益人的资源使用和护理质量。
设计、设置和参与者：这项队列研究使用了 2015 年 1 月至 2019 年 12 月的 TM 索赔和 MA 遭遇记录。参与者为 2016 年 1 月至 2019 年 12 月期间开始癌症化疗的 MA 和 TM 受益人的。采用逆概率治疗加权法在 MA 和 TM 受益人之间平衡特征，并采用回归估计法进行分析。分析于 2023 年 8 月至 2024 年 5 月进行。
化疗启动前有 1 年洗脱期。
在化疗启动后的 6 个月内测量资源使用和护理质量。资源使用使用 MA 和 TM 中服务的标准化价格进行衡量，包括医院住院服务、门诊护理、处方 D 药物和临终关怀服务。化疗利用情况考察了 B 部分化疗、B 部分辅助药物和 D 部分化疗。质量措施包括与化疗相关的急诊（ED）就诊和住院、可避免的 ED 就诊、6 个月发作期间可预防的住院、以及从化疗开始到 18 个月的生存天数。
该研究纳入了 96501 名 MA 参保人，共涉及 98872 例（平均[SD]年龄，72.9[7.6]岁；55859[56.5%]为女性；7371[7.5%]为西班牙裔，14778[14.9%]为非西班牙裔黑人，75130[75.0%]为非西班牙裔白人参与者）和 206274 名 TM 受益人，共涉及 212969 例（平均[SD]年龄，72.7[8.3]岁；121263[56.9%]为女性；8356[3.9%]为西班牙裔，16693[7.8%]为非西班牙裔黑人，182228[85.6%]为非西班牙裔白人参与者）。在 6 个月的发作期间，MA 每名参保人（62599 美元）的总资源使用比 TM（71317 美元）低 8718 美元（95%CI，6343 美元至 9094 美元）。B 部分化疗资源使用占总资源使用差异的大部分，MA 参保人比 TM 受益人少使用 5032 美元（95%CI，4772 美元至 5293 美元）。MA 中 B 部分化疗使用率较低，与化疗就诊次数减少（-1.06 次；95%CI，-1.10 次至-1.02 次就诊）和每次化疗费用降低（-277 美元；95%CI，-275 美元至-179 美元）有关。质量方面的结果喜忧参半，但重要的是，接受化疗的 MA 和 TM 患者的生存时间没有差异。
在这项对接受化疗的癌症医疗保险受益人的队列研究中，MA 参保与资源使用减少但生存时间无差异有关。
