Hu Jianhui, Nerenz David R
Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, Suite 5E, Detroit, MI, 48202, USA.
BMC Health Serv Res. 2025 Jan 28;25(1):157. doi: 10.1186/s12913-024-12188-1.
The 340B Drug Pricing Program has been controversial since its inception in 1992, a major criticism being that 340B hospitals use more outpatient drugs, and more expensive drugs, because of financial incentives to "make money" through the program. The goal of this study was to determine whether characteristics of patients treated at 340B hospitals, and affiliation of hospitals with NCI-designated cancer centers, would explain higher Part B drug costs and use of more expensive chemotherapy drugs.
This is an observational study using data from SEER-Medicare and 340B entity database. Fee-for-service Medicare beneficiaries who were first diagnosed with cancer between 1/1/2013 and 12/31/2015 were included. Hospital, patient, and cancer/clinical characteristics were used as predictors of both overall Part B drug costs and use of expensive chemotherapy drugs. Patient characteristics and cancer conditions were compared between those who were treated at 340B and non-340B hospitals, and between those who used and who did not use any expensive chemotherapy treatment. Independent relationships between overall Part B drug costs and patients' 340B status, and between patients' use of expensive chemotherapy drug and patients' 340B status were evaluated in multivariate analyses, using a "stepwise" generalized estimating equation modeling approach.
We found that patients at 340B hospitals had a somewhat higher chance of using one of the ten expensive chemotherapy drugs, and somewhat higher overall drug costs, but these relationships became non-significant when patient, cancer/clinical factors, and cancer center status were considered. Compared to the reference patients, patients who were treated in an NCI-designated cancer center or a hospital affiliated with such center, who had certain types of cancers (e.g., B-cell), or had advanced-stage disease had a higher chance to use expensive chemotherapy treatment; patients who were older, survived the first 12 months upon diagnosis, had advanced-stage disease, or had more drug claims had higher drug costs.
Hospital 340B status was not significantly associated with use of more expensive cancer drugs or drug costs once other relevant factors (e.g., cancer center status, advanced-stage disease) were taken into account.
340B药品定价计划自1992年启动以来一直备受争议，主要批评意见是340B医院因通过该计划“赚钱”的经济激励而使用更多的门诊药物和更昂贵的药物。本研究的目的是确定在340B医院接受治疗的患者特征以及医院与美国国立癌症研究所指定癌症中心的附属关系，是否能解释较高的B部分药物成本以及使用更昂贵的化疗药物的情况。
这是一项使用监测、流行病学与最终结果（SEER）-医疗保险数据和340B实体数据库进行的观察性研究。纳入了2013年1月1日至2015年12月31日期间首次被诊断为癌症的按服务收费的医疗保险受益人。医院、患者以及癌症/临床特征被用作总体B部分药物成本和使用昂贵化疗药物的预测因素。比较了在340B医院和非340B医院接受治疗的患者之间，以及使用和未使用任何昂贵化疗治疗的患者之间的患者特征和癌症情况。在多变量分析中，使用“逐步”广义估计方程建模方法评估了总体B部分药物成本与患者的340B状态之间，以及患者使用昂贵化疗药物与患者的340B状态之间的独立关系。
我们发现，340B医院的患者使用十种昂贵化疗药物之一的可能性略高，总体药物成本也略高，但在考虑患者、癌症/临床因素和癌症中心状态后，这些关系变得不显著。与参考患者相比，在国立癌症研究所指定癌症中心或附属此类中心的医院接受治疗、患有某些类型癌症（如B细胞癌）或患有晚期疾病的患者使用昂贵化疗治疗的可能性更高；年龄较大、诊断后存活前12个月、患有晚期疾病或有更多药物索赔的患者药物成本更高。
一旦考虑其他相关因素（如癌症中心状态、晚期疾病），医院的340B状态与使用更昂贵的癌症药物或药物成本并无显著关联。
