Disease-related costs of care and survival among Medicare-enrolled patients with myelodysplastic syndromes

Amer M. Zeidan, Rong Wang, Amy J. Davidoff, Shuangge Ma, Yinjun Zhao, Steven D. Gore, Cary P. Gross, Xiaomei Ma

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - 2016
Externally publishedYes

Fingerprint

Cost of Illness
Myelodysplastic Syndromes
Medicare
Costs and Cost Analysis
Survival
Registries
Confidence Intervals
Propensity Score
International Classification of Diseases
Health Expenditures
Proportional Hazards Models
Epidemiology
Research Design
Survival Rate
Databases

Keywords

  • Cost
  • Hypomethylating agents
  • Myelodysplastic syndromes
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Zeidan, A. M., Wang, R., Davidoff, A. J., Ma, S., Zhao, Y., Gore, S. D., ... Ma, X. (Accepted/In press). Disease-related costs of care and survival among Medicare-enrolled patients with myelodysplastic syndromes. Cancer. https://doi.org/10.1002/cncr.29945

Disease-related costs of care and survival among Medicare-enrolled patients with myelodysplastic syndromes. / Zeidan, Amer M.; Wang, Rong; Davidoff, Amy J.; Ma, Shuangge; Zhao, Yinjun; Gore, Steven D.; Gross, Cary P.; Ma, Xiaomei.

In: Cancer, 2016.

Research output: Contribution to journalArticle

Zeidan, Amer M. ; Wang, Rong ; Davidoff, Amy J. ; Ma, Shuangge ; Zhao, Yinjun ; Gore, Steven D. ; Gross, Cary P. ; Ma, Xiaomei. / Disease-related costs of care and survival among Medicare-enrolled patients with myelodysplastic syndromes. In: Cancer. 2016.
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abstract = "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.",
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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

PY - 2016

Y1 - 2016

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

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