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Medicare spending disparities failed to affect cancer outcomes
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Medicare spending differed in various regions in the United States, but the disparity was not linked to differences in cancer outcomes, according to study results.
Researchers used SEER databases to evaluate data on 116,523 patients with advanced cancer.
Eligible patients were aged 65 years and older, and they were diagnosed between 2002 and 2007 with non–small cell lung, colon, breast, prostate or pancreas cancer. There were 61,083 patients in the incident advanced-stage cancer cohort and 98,935 who had died of cancer, which the researchers identified as the decedent cohort. Researchers analyzed data for 37% of patients in both cohorts.
Survival served as the primary outcome measure and was assessed in the incident cohort.
“The exposure measure was the quintile of regional spending in the decedent cohort,” the researchers wrote.
The investigators compared survival in the lowest spending quintile (quintile one) with survival in the other quintiles (two through five).
The mean increase in regional spending from quintile one to quintile five was 32% in the incident cohort. This increase was 41% in the decedent cohort.
Variation was observed in the link between spending and survival. These variations occurred by cancer site and quintile. At the low end, the HR for pancreas cancer in quintile five was 0.92 (95% CI, 0.82-1.04), and at the high end, the HR for breast cancer in quintile three was 1.24 (95% CI, 1.11-1.39).
In most instances, survival differences between the first quintile and the second through fifth quintiles were not statistically significant.
“There is substantial regional variation in Medicare spending for advanced cancer, yet no consistent association between mean regional spending and survival,” the researchers concluded.
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