Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy
Medicare D Subsidies and Racial Disparities in Persistence and Adherence With Hormonal Therapy
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DOI：
10.1200/jco.2016.67.3350
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发表时间：
2016-12-20
影响因子：
45.3
通讯作者：
Neuner, Joan M.
中科院分区：
文献类型：
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作者：
Biggers, Alana;Shi, Yushu;Neuner, Joan M.
目的调查通过医疗保险D部分低收入补贴对乳腺癌激素治疗持续性和坚持性的差异的自付费用支持的作用。在2006年至2007年期间进行乳腺癌手术的65岁患者中，从所有Medicare D登记者中确定了至少一种口服乳腺癌激素治疗处方。研究了种族或民族与非持续性（连续90天没有要求激素治疗处方）和非依从性（药物拥有率<80%）的关系。生存分析被用来占潜在的差异，年龄，合并症，或强度的其他treatment.ResultsAmong的25,111名妇女在研究样本中，77%的西班牙裔和70%的黑人妇女获得补贴相比，21%的白色妇女。到2年时，69%的黑人和70%的西班牙裔患者持续存在，而白色患者为61%。在校正分析中，所有3个未补贴人种或种族组的患者停药率均高于补贴组（白色患者：风险比[HR]，1.83; 95% CI，1.70 - 1.95;黑人患者：HR，2.09; 95% CI，1.73 - 2.51;西班牙裔患者：HR，3.00; 95% CI，2.37 - 3.89）。种族或民族的持久性差异，目前为无补贴的患者不存在或逆转补贴的患者。所有三个补贴的种族或族裔群体也有较高的坚持比所有三个unsubsidized组，虽然与最小的差异发生在黑人women.ConclusionReceived处方补贴与乳腺癌激素治疗的持久性大大提高白色，黑人和西班牙裔妇女和缺乏种族或族裔差异的持久性。鉴于黑人和西班牙裔妇女的高补贴入学率，针对低收入患者的政策也有可能大大减少种族和民族差异。(C)2016年美国临床肿瘤学会
PurposeTo investigate the role of out-of-pocket cost supports through the Medicare Part D Low-Income Subsidy on disparities in breast cancer hormonal therapy persistence and adherence by race or ethnicity.MethodsA nationwide cohort of women age >= 65 years with a breast cancer operation between 2006 and 2007 and at least one prescription filled for oral breast cancer hormonal therapy was identified from all Medicare D enrollees. The association of race or ethnicity with nonpersistence (90 consecutive days with no claims for a hormonal therapy prescription) and nonadherence (medication possession rate < 80%) was examined. Survival analyses were used to account for potential differences in age, comorbidity, or intensity of other treatments.ResultsAmong the 25,111 women in the study sample, 77% of the Hispanic and 70% of the black women received a subsidy compared with 21% of the white women. By 2 years, 69% of black and 70% of Hispanic patients were persistent compared with 61% of white patients. In adjusted analyses, patients in all three unsubsidized race or ethnicity groups had greater discontinuation than subsidized groups (white patients: hazard ratio [HR], 1.83; 95% CI, 1.70 to 1.95; black patients: HR, 2.09; 95% CI, 1.73 to 2.51; Hispanic patients: HR, 3.00; 95% CI, 2.37 to 3.89). Racial or ethnic persistence disparities that were present for unsubsidized patients were not present or reversed among subsidized patients. All three subsidized race or ethnicity groups also had higher adherence than all three unsubsidized groups, although with the smallest difference occurring in black women.ConclusionReceipt of a prescription subsidy was associated with substantially improved persistence to breast cancer hormonal therapy among white, black, and Hispanic women and lack of racial or ethnic disparities in persistence. Given high subsidy enrollment among black and Hispanic women, policies targeted at low-income patients have the potential to also substantially reduce racial and ethnic disparities. (C) 2016 by American Society of Clinical Oncology