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Medicare and patient spending among beneficiaries diagnosed with chronic myelogenous leukemia
Author(s) -
Kenzik Kelly M.,
Bhatia Ravi,
Williams Grant R.,
Bhatia Smita
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32137
Subject(s) - medicine , chronic myelogenous leukemia , epidemiology , imatinib , imatinib mesylate , nilotinib , emergency medicine , leukemia , myeloid leukemia
Background The authors examined Medicare spending and patient spending in older patients with chronic myelogenous leukemia (CML) over the first 5 years from the time of CML diagnosis in the tyrosine kinase inhibitor (TKI) era. Methods Medicare beneficiaries with CML who were diagnosed between 2007 and 2012 at age >65 years were identified from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database (805 beneficiaries). A noncancer Medicare beneficiary sample was frequency‐matched based on age, sex, and race/ethnicity (805 individuals). Patients were followed until 5 years from diagnosis, disenrollment, death, or December 31, 2014, whichever came first. Total Medicare spending, service‐specific spending, and amount owed by patients was estimated monthly and then summed over 60 months and averaged to generate annual spending. Results The median age at the time of diagnosis of CML was 76 years (range, 66‐102 years). Overall, 51.4% of patients received TKIs (27.8% received imatinib alone), 28% received non‐TKI therapy, and 21% received no treatment. The 5‐year survival rate for patients with ≥85% time receiving TKIs was 79% compared with 76% for noncancer controls versus 62% for those with <85% time receiving TKIs. Annual Medicare spending was found to be significantly higher for patients treated with TKIs ($143,053) compared with those treated without TKIs ($41,268 vs $10,498 for noncancer controls). Annual patient cost responsibility was $11,712 per patient receiving any TKIs versus $7330 for those receiving non‐TKI outpatient chemotherapy versus $3561 for noncancer controls. Conclusions Older patients with CML with adequate time receiving TKI therapy have 5‐year survival rates that are comparable to those of their counterparts without cancer. However, TKI use is accompanied with significant Medicare and patient spending; patients receiving multiple TKIs (ie, dasatinib or nilotinib along with imatinib) constitute the group with the highest spending.