Mitchell Aaron P, Persaud Sonia, Mishra Meza Akriti, Fuchs Hannah E, De Prabal, Tabatabai Sara, Chakraborty Nirjhar, Dey Pranam, Trivedi Niti U, Mailankody Sham, Blinder Victoria, Green Angela, Epstein Andrew S, Daly Bobby, Roeker Lindsey, Bach Peter B, Gönen Mithat
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
J Clin Oncol. 2025 Feb 10;43(5):524-535. doi: 10.1200/JCO.24.00459. Epub 2024 Oct 11.
The Medicare part D Low-Income Subsidy (LIS) improves access to oral cancer drugs, but provides no assistance for clinician-administered/part B drugs. This analysis assessed the association between LIS participation and receipt of optimal cancer treatment.
We investigated initial systemic therapy using SEER-Medicare data (2015-2017) and National Comprehensive Cancer Network (NCCN) Evidence Blocks (EB) as the standard for treatment recommendations. We included cancer clinical scenarios wherein (1) ≥one treatment was optimal (higher efficacy and safety scores) versus other treatments; (2) identifiable in SEER-Medicare (eg, not defined by clinical data unavailable in registry data or claims); and (3) both EB and ASCO Value Framework agreed regarding optimal treatment. We fit logistic regression models to assess the association between receipt of systemic therapy ( no therapy) and patient and provider characteristics. Contingent on receipt of treatment, we modeled the likelihood of receiving a treatment ranked (by EB scores) within the highest or lowest quartile for that cancer type.
Nine thousand two hundred and ninety patients were included across 11 clinical scenarios. Fifty-seven percent (5,336) of patients received any systemic therapy and 43% (3,954) received no systemic therapy. Compared with non-LIS participants, LIS participants were less likely to receive any systemic therapy versus no systemic therapy (odds ratio, 0.64 [95% CI, 0.57 to 0.72]). Contingent on receiving systemic therapy, LIS participants received treatment ranked within the worst quartile 24.8% of the time, compared with 21.9% of non-LIS patients (adjusted prevalence difference, 4.3% [95% CI, 0.5 to 8.2]).
LIS participants were less likely to receive systemic therapy at all and were more likely to receive treatments that receive low NCCN EB scores.
医疗保险D部分低收入补贴（LIS）改善了口腔癌药物的可及性，但对于临床医生给药的/乙类药物未提供任何援助。本分析评估了LIS参与情况与接受最佳癌症治疗之间的关联。
我们使用监测、流行病学和最终结果（SEER）医保数据（2015 - 2017年）以及美国国立综合癌症网络（NCCN）证据模块（EB）作为治疗推荐标准，对初始全身治疗进行了调查。我们纳入了癌症临床病例，其中（1）与其他治疗相比，≥一种治疗是最佳的（疗效和安全性评分更高）；（2）在SEER医保数据中可识别（例如，不是由登记数据或理赔中不可用的临床数据定义的）；（3）EB和美国临床肿瘤学会（ASCO）价值框架在最佳治疗方面达成一致。我们拟合逻辑回归模型，以评估接受全身治疗（无治疗）与患者及医疗服务提供者特征之间的关联。根据接受治疗的情况，我们对接受按该癌症类型的EB评分排在最高或最低四分位数内的治疗的可能性进行了建模。
11种临床病例共纳入9290名患者。57%（5336名）的患者接受了任何全身治疗，43%（3954名）的患者未接受全身治疗。与非LIS参与者相比，LIS参与者接受任何全身治疗而非不接受全身治疗的可能性较小（优势比，0.64 [95%置信区间，0.57至0.72]）。在接受全身治疗的情况下，LIS参与者有24.8%的时间接受排在最差四分位数内的治疗，而非LIS患者为21.9%（调整后的患病率差异，4.3% [95%置信区间，0.5至8.2]）。
LIS参与者总体接受全身治疗的可能性较小，且更有可能接受NCCN EB评分较低的治疗。
