TY - JOUR
T1 - Disease-related costs of care and survival among Medicare-enrolled patients with myelodysplastic syndromes
AU - Zeidan, Amer M.
AU - Wang, Rong
AU - Davidoff, Amy J.
AU - Ma, Shuangge
AU - Zhao, Yinjun
AU - Gore, Steven D.
AU - Gross, Cary P.
AU - Ma, Xiaomei
N1 - Funding Information:
The collection of California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; by the National Cancer Institute-?s Surveillance, Epidemiology, and End Results Program under contract N01- PC- 35136 awarded to the Northern California Cancer Center, under contract N01- PC- 35139 awarded to the University of Southern California, and under contract N02- PC- 15105 awarded to the Public Health Institute; and by the National Program of Cancer Registries (Centers for Disease Control and Prevention) under agreement U55/CCR921930- 02 awarded to the Public Health Institute.
Publisher Copyright:
© 2016 American Cancer Society.
PY - 2016/5/15
Y1 - 2016/5/15
N2 - BACKGROUND Although newer treatments for myelodysplastic syndromes (MDS), particularly hypomethylating agents (HMAs), are expensive, it is unclear whether MDS-related costs of care are associated with overall survival. This study evaluated the relation between MDS-related costs and survival among Medicare beneficiaries with MDS. METHODS Eligible patients were identified from the Surveillance, Epidemiology, and End Results-Medicare database with codes for MDS from International Classification of Diseases for Oncology, 3rd edition. The patients were diagnosed between January 1, 2005 and December 31, 2011, were 66 years old or older, and were followed through death or the end of study (December 31, 2012). Medicare payments were used to estimate costs. Cumulative costs in a propensity score-matched group of cancer-free Medicare beneficiaries were subtracted from costs in the MDS cohort in each registry to estimate MDS-related costs. Hazard ratios (HRs) and 95% confidence intervals (CIs) were derived from multivariate Cox proportional hazards models adjusted for patient and disease characteristics. RESULTS There were 8580 eligible patients, and 1,267 (14.7%) received HMAs. The overall 2-year survival rate was 48.7%, and the 2-year registry-specific MDS-related cost per patient ranged from $40,793 to $78,156 across 16 registries. The 2-year MDS-related cost was not associated with survival in the overall study population (first tertile, reference; second tertile, HR, 0.96; 95% CI, 0.89-1.04; P =.29; third tertile, HR, 0.98; 95% CI, 0.91-1.06; P =.64) or in subgroups of patients who did or did not receive HMAs. CONCLUSIONS Medicare expenditures for elderly patients with MDS varied across registries but were not associated with survival. A lack of an association between costs and outcomes warrants additional research because it may help to identify potential areas for cost-saving interventions without compromising patient outcomes.
AB - BACKGROUND Although newer treatments for myelodysplastic syndromes (MDS), particularly hypomethylating agents (HMAs), are expensive, it is unclear whether MDS-related costs of care are associated with overall survival. This study evaluated the relation between MDS-related costs and survival among Medicare beneficiaries with MDS. METHODS Eligible patients were identified from the Surveillance, Epidemiology, and End Results-Medicare database with codes for MDS from International Classification of Diseases for Oncology, 3rd edition. The patients were diagnosed between January 1, 2005 and December 31, 2011, were 66 years old or older, and were followed through death or the end of study (December 31, 2012). Medicare payments were used to estimate costs. Cumulative costs in a propensity score-matched group of cancer-free Medicare beneficiaries were subtracted from costs in the MDS cohort in each registry to estimate MDS-related costs. Hazard ratios (HRs) and 95% confidence intervals (CIs) were derived from multivariate Cox proportional hazards models adjusted for patient and disease characteristics. RESULTS There were 8580 eligible patients, and 1,267 (14.7%) received HMAs. The overall 2-year survival rate was 48.7%, and the 2-year registry-specific MDS-related cost per patient ranged from $40,793 to $78,156 across 16 registries. The 2-year MDS-related cost was not associated with survival in the overall study population (first tertile, reference; second tertile, HR, 0.96; 95% CI, 0.89-1.04; P =.29; third tertile, HR, 0.98; 95% CI, 0.91-1.06; P =.64) or in subgroups of patients who did or did not receive HMAs. CONCLUSIONS Medicare expenditures for elderly patients with MDS varied across registries but were not associated with survival. A lack of an association between costs and outcomes warrants additional research because it may help to identify potential areas for cost-saving interventions without compromising patient outcomes.
KW - cost
KW - hypomethylating agents
KW - myelodysplastic syndromes
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=84960349287&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84960349287&partnerID=8YFLogxK
U2 - 10.1002/cncr.29945
DO - 10.1002/cncr.29945
M3 - Article
C2 - 26970288
AN - SCOPUS:84960349287
VL - 122
SP - 1598
EP - 1607
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 10
ER -