Medicare and patient spending among beneficiaries diagnosed with chronic myelogenous leukemia.
Medicare and patient spending among beneficiaries diagnosed with chronic myelogenous leukemia.
复制标题
诊断患有慢性粒细胞白血病的受益人的医疗保险和患者支出。
作者：
Kenzik,KellyM;Bhatia,Ravi;Williams,GrantR;Bhatia,Smita
背景：在酪氨酸激酶抑制剂（TKI）时代，作者检查了老年慢性粒细胞白血病（CML）患者自CML诊断后的前5年内的医疗保险支出和患者支出。方法从监测、流行病学和最终结果(SEER) -Medicare数据库（805名受益人）中确定2007年至2012年期间诊断为CML的医疗保险受益人，年龄在bb0 ~ 65岁之间。非癌症医疗保险受益人样本基于年龄、性别和种族/民族进行频率匹配（805人）。从诊断、退组、死亡或2014年12月31日起随访患者5年，以先到者为准。医疗保险总支出、特定服务支出和患者所欠金额按月估算，然后在60个月内相加并取平均值，得出年度支出。结果CML诊断时的中位年龄为76岁（范围66 ~ 102岁）。总体而言，51.4%的患者接受TKI治疗（27.8%的患者单独接受伊马替尼治疗），28%的患者接受非TKI治疗，21%的患者未接受治疗。接受TKIs时间≥85%的患者的5年生存率为79%，非癌症对照组为76%，而接受TKIs时间< 85%的患者为62%。研究发现，接受tki治疗的患者的年度医疗保险支出（143,053）明显高于未接受tki治疗的患者（41,268 vs非癌症对照的10,498）。每位接受tki治疗的患者每年的患者成本责任为11,712美元，而接受非tki门诊化疗的患者为7330美元，而非癌症对照组为3561美元。结论：接受TKI治疗的老年CML患者的5年生存率与未患癌症的老年CML患者相当。然而，TKI的使用伴随着显著的医疗保险和患者支出；接受多种tki（即达沙替尼或尼洛替尼与伊马替尼一起使用）的患者构成了支出最高的群体。
Background The authors examined Medicare spending and patient spending in older patients with chronic myelogenous leukemia (CML) over the first 5 years from the time of CML diagnosis in the tyrosine kinase inhibitor (TKI) era. Methods Medicare beneficiaries with CML who were diagnosed between 2007 and 2012 at age> 65 years were identified from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database (805 beneficiaries). A noncancer Medicare beneficiary sample was frequency‐matched based on age, sex, and race/ethnicity (805 individuals). Patients were followed until 5 years from diagnosis, disenrollment, death, or December 31, 2014, whichever came first. Total Medicare spending, service‐specific spending, and amount owed by patients was estimated monthly and then summed over 60 months and averaged to generate annual spending. Results The median age at the time of diagnosis of CML was 76 years (range, 66‐102 years). Overall, 51.4% of patients received TKIs (27.8% received imatinib alone), 28% received non‐TKI therapy, and 21% received no treatment. The 5‐year survival rate for patients with≥ 85% time receiving TKIs was 79% compared with 76% for noncancer controls versus 62% for those with< 85% time receiving TKIs. Annual Medicare spending was found to be significantly higher for patients treated with TKIs (143,053)comparedwiththosetreatedwithoutTKIs( 41,268 vs 10,498fornoncancercontrols).Annualpatientcostresponsibilitywas 11,712 per patient receiving any TKIs versus 7330forthosereceivingnon‐TKIoutpatientchemotherapyversus 3561 for noncancer controls. Conclusions Older patients with CML with adequate time receiving TKI therapy have 5‐year survival rates that are comparable to those of their counterparts without cancer. However, TKI use is accompanied with significant Medicare and patient spending; patients receiving multiple TKIs (ie, dasatinib or nilotinib along with imatinib) constitute the group with the highest spending.