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Use of and spending on supportive care medications among Medicare beneficiaries with cancer

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Abstract

Purpose

The study objective was to provide population-based estimates of supportive care medication (SCM) use among Medicare beneficiaries with cancer and determine factors related to SCM receipt.

Methods

This retrospective cohort study of community-based Medicare beneficiaries used the Medicare Current Beneficiary Survey (1997–2007). Dependent variables comprised use and spending on SCMs for three medication classes: opioids, antidepressants/sedative/hypnotics (ASH), and antiemetics. Independent variables of interest were supplemental insurance coverage, cancer site, and treatment. Multivariate models determined factors affecting receipt of, and spending on, SCMs. We also compared SCM use and spending among beneficiaries with and without cancer in order to understand what portion of SCM use and spending could be attributed to cancer as opposed to other comorbid conditions.

Results

A total of 1,836 Medicare beneficiaries with cancer and 9,898 beneficiaries without cancer were eligible for the study. Beneficiaries with cancer were more likely to receive opioids, ASH, and antiemetics compared to non-cancer beneficiaries. Adjusted annual payments for antiemetics were on average $637 higher in with cancer versus without cancer (p < 0.01), while ASH payments were $184 lower (p < 0.01). Opioid spending was similar among cancer and non-cancer users. Relative to colon cancer, beneficiaries with prostate cancer were least likely to receive any of the three SCM classes. Receipt of antineoplastic treatment increased the probability of use of all three classes of SCMs. Insurance coverage did not influence the use of or spending on opioids or antiemetics, but was associated with both outcomes for ASH. The use of all three SCM classes was significantly lower during years before Part D implementation of the new Medicare Part D prescription drug benefit and was higher after implementation of Part D.

Conclusion

This study provides population-based information on SCM use among Medicare beneficiaries with cancer. Cancer site and treatment modality were important predictors of SCM use.

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Acknowledgments

Funding sources American Cancer Society RSGI-10-109-01-CPHPS and Supplemental Medical and Drug Insurance and Cancer Related Spending are gratefully acknowledged by the authors.

Disclaimer

This article was initiated while Dr. Davidoff was employed at the University of Maryland Baltimore. The opinions expressed in this article are the author’s own and do not reflect the view of the Agency for Healthcare Research and Quality, the Department of Health and Human Services, or the US government.

Presentations

Portions of this paper were presented at Harry and Elsa Jiler—American Cancer Society Professors Meeting, November 1, 2011.

Conflict of interest

None of the authors have a personal financial relationship with the organization that sponsored the research. The sponsor (American Cancer Society) had no role in the design, methods, data collection, analysis, or preparation of the paper.

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Authors and Affiliations

  1. Peter Lamy Center on Drug Therapy and Aging, Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA

    Ilene H. Zuckerman, Amy J. Davidoff, Bruce Stuart, Thomas Shaffer, J. Samantha Dougherty & Candice Yong

  2. IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA

    Ilene H. Zuckerman

  3. Agency for Healthcare Research and Quality, Rockville, MD, USA

    Amy J. Davidoff

  4. Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA

    Mujde Z. Erten

  5. Pharmaceutical Research and Manufacturers of America, Washington, DC, USA

    J. Samantha Dougherty

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  1. Ilene H. Zuckerman
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Correspondence to Ilene H. Zuckerman.

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Zuckerman, I.H., Davidoff, A.J., Erten, M.Z. et al. Use of and spending on supportive care medications among Medicare beneficiaries with cancer. Support Care Cancer 22, 2185–2195 (2014). https://doi.org/10.1007/s00520-014-2187-2

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