Are Disparities in Cancer Chemotherapy Treatment Affected by Medicare Reimburseme

描述（由申请人提供）：2003年医疗保险现代化法案（MMA）规定大幅降低门诊化疗药物的支付率。MMA于2005年1月1日生效的改革规定，肿瘤药物供应商获得的利润上限为高于制造商平均（全国）销售价格6%。与此同时，医疗保险增加了化疗费用。这项研究将建立在我们对MMA对患有肺癌和结直肠癌的医疗保险受益人化疗治疗的总体影响的分析之上。在我们最近提交发表的工作中，我们发现医生对MMA支付变化的反应是为更多的肺癌医疗保险受益人提供化疗治疗（Jacobson et al. 2009）。给患者使用的药物类型也发生了变化。以前高利润药物的使用比付款减少之前少了，更昂贵的代理商越来越多，如果适度的话，对所有药物征收6%的利润率。我们对结直肠癌患者的分析仍在进行中，尽管我们怀疑我们会发现类似的结果。这项研究的目的是了解癌症药物支付率的巨大变化如何影响癌症治疗的差异。利用监测流行病学和最终结果（SEER）项目的数据，这些数据与2003年至2006年期间诊断为肺癌和结直肠癌的受益人的医疗保险索赔以及2002年至2008年期间这些人的所有相关索赔有关，我们计划扩展我们最近完成的肺癌研究和正在进行的结直肠癌研究，以了解mma相关的治疗变化是否不成比例地集中在某些医疗保险受益人群体中，而不是其他群体，以及是否由于支付改革而扩大了现有的差距。本研究旨在分析：目的1)MMA对癌症药物支付率的变化如何影响结直肠癌和肺癌受益人癌症化疗治疗的差异。目的2)MMA在支付率方面的变化如何影响那些接受化疗的患者所使用的药物类型的差异。目标3)MMA支付率的变化如何影响结直肠癌和肺癌受益人的生存差异我们提出的工作将是支付改革对差异变化影响的极少数研究之一。此外，据我们所知，这将是第一个寻求具体了解MMA如何在不同人口和地理群体中差异影响化疗治疗和结果的研究。

DESCRIPTION (provided by applicant): The Medicare Modernization Act of 2003 (MMA) mandated substantial reductions in payment rates for outpatient chemotherapy drugs. The MMA's changes, which took effect on January 1, 2005, capped the margins providers receive on oncology drugs at 6 percent above manufacturers' average (national) sales prices. At the same time, Medicare increased the fees for chemotherapy administration. This study will build on our analysis of the overall effects of the MMA on chemotherapy treatment for Medicare beneficiaries with lung and colorectal cancer. In work we recently submitted for publication, we found that doctors responded to the MMA's payment changes by providing chemotherapy treatment to a greater share of Medicare beneficiaries with lung cancer (Jacobson et al. 2009). The type of agents administered to patients also changed. Previously high margin drugs were used less commonly than prior to the payment reduction and more expensive agents were increasingly, if modestly, favored by the 6 percent margin imposed on all drugs. Our analysis of beneficiaries with colorectal cancer is ongoing, although we suspect we will find similar results. The goal of this study is to understand how the large change in payment rates for cancer drugs has affected disparities in cancer treatment. Using data on the Surveillance Epidemiology and End Results (SEER) Program linked to Medicare claims for beneficiaries diagnosed with lung and colorectal cancer between 2003 and 2006 and all associated claims for these individuals from 2002 to 2008, we plan to extend our recently completed work on lung cancer and ongoing work on colorectal cancer to understand if the MMA-related changes in treatment are concentrated disproportionately in some groups of Medicare beneficiaries rather than others and if, as a result, existing disparities widen as a result of the payment reform. The proposed study aims to analyze: Aim 1) how the MMA's changes in payment rates for cancer drugs has affected disparities in cancer chemotherapy treatment for beneficiaries with colorectal and lung cancer. Aim 2) how the MMA's changes in payment rates has affected disparities in the type of drugs administered to those patients who receive any chemotherapy treatment. Aim 3) how the MMA's changes in payment rates has affected disparities in survival for beneficiaries with colorectal and lung cancer Our proposed work would be among the very few studies of the effects of payment reforms on changes in disparities. Moreover, it would be the first, to our knowledge, that seeks to specifically understand how the MMA differentially affected chemotherapy treatment and outcomes across demographic and geographic groups. PUBLIC HEALTH RELEVANCE: The Medicare Modernization Act of 2003 (MMA) mandated substantial reductions in payment rates for outpatient chemotherapy drugs. In work recently submitted, we find that in response the MMA's payment change, Medicare beneficiaries with lung cancer are more likely to receive chemotherapy treatment and, conditional on such treatment, are more likely to receive expensive agents. The goal of the proposed study is to determine how, if at all, these changes have affected disparities in chemotherapy treatment and outcomes.