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Higher costs not associated with improved OS in myelodysplastic syndrome
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Although Medicare expenditures varied among older patients with myelodysplastic syndromes, higher costs did not appear correlated with improved survival outcomes, according to the results of an observational study.
“The costs of care for patients with cancer continue to rise in the United States due to the advent of effective but very expensive therapies, significantly contributing to the rapidly increasing costs of health care in the country,” Amer M. Zeidan, MBBS, MHS, assistant professor of medicine at Yale University, told HemOnc Today. “Substantial geographic variation in health care spending, including spending on cancer care, has been documented in America. However, little is known about regional variation in the cost of treating patients with myelodysplastic syndrome [MDS], and whether the costs of care for these patients correlate with survival.”
Amer M. Zeidan
Zeidan and colleagues sought to determine whether a correlation existed between MDS–related costs and OS among Medicare beneficiaries.
They used the SEER–Medicare database to identify 8,580 geriatric patients (median age, 80 years; interquartile range, 74-85; 53% men) diagnosed between January 2005 and December 2011.
Cost estimates were made using Medicare estimates. To estimate MDS–related costs, the researchers deducted cumulative costs in a propensity score-matched cohort of cancer-free Medicare recipients.
In total, 14.7% (n = 1,267) of patients received hypomethylating agents for MDS. The entire cohort had a 2-year OS of 48.7%, with median survival of 1.84 years.
The OS rate among users of hypomethylating agents was 37.4%, compared with 49.4% among nonusers.
MDS–related costs per patient ranged from $40,793 (New Mexico) to $78,156 (Detroit) across 16 registries.
Nearly all patients with refractory anemia in excess blasts (n = 1,055) experienced 2-year MDS–related costs of nearly $100,000 or higher (range $99,035-$177,884), with the exception of patients in New Mexico ($47,845).
However, the 2-year MDS–related costs of treatment did not have an effect on OS in the overall study population. Patients with costs in the second tertile (HR = 0.96; 95% CI, 0.89-1.04) and third tertile (HR = 0.98; 95% CI, 0.91-1.06) did not have improved outcomes compared with patients with the lowest costs, or those in the first tertile.
The researchers acknowledged these results may not be generalizable because the study included only Medicare-enrolled patients.
They further noted that they were unable to access important disease-related clinical variables — such as karyotypic abnormalities, blast counts and blood counts — that were not included in the database, nor could they determine whether therapy choices were made by clinicians or patients.
“MDS is a rare form of cancer and difficult to study epidemiologically,” Zeidan said. “Our study evaluated patients at the population level, in contrast to clinical trials which study a relatively small number of patients who meet stringent selection criteria. The lack of association between costs of care and survival warrants additional research to evaluate the underlying factors as they may represent potential opportunities for introducing cost-saving interventions and improve the inefficiencies in the health system without compromising the clinical outcomes of patients.” – by Cameron Kelsall
For more information:
Amer M. Zeidan, MBBS, MHS, can be reached at amer.zeidan@yale.edu.
Disclosure: Zeidan reports a consultant role with Celgene. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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