Erythropoiesis-stimulating agent use after changes in medicare reimbursement policies

Dawn L. Hershman, Alfred I. Neugut, Jin Joo Shim, Sharon Glied, Wei Yann Tsai, Jason D. Wright

Research output: Contribution to journalArticle

Abstract

Purpose: Since 2004, concerns about the safety of erythropoiesis-stimulating agents (ESAs) have resulted in label changes and restrictions on their use. We examined changes in ESA use and blood transfusions over time. Methods: The SEER-Medicare database was used to identify patients age ≥ 65 years with breast, lung, prostate, ovary, or colon cancer, diagnosed between 2000 and 2007, who had a chemotherapy claim after their cancer diagnosis. We calculated the mean number of ESA claims per patient per year. Follow-up claims were available through 2008. We used multivariable logistic regression models to analyze the association of ESA use and extended ESA use with clinical and demographic variables. Results: Among 121,169 patients identified, 46,063 (38%) received an ESA. ESA use increased from 12.4% to 16.2% by 2006 and then decreased to 7.9% by 2008. Similarly, the mean number of ESA claims per patient decreased steadily over the entire timeframe. The annual percentage of patients undergoing transfusion remained relatively constant (9% to 10%). In a Cox proportional hazards time-dependent model, ESA use was positively associated with black race (odds ratio [OR], 1.11; 95% CI, 1.07 to 1.15), metropolitan location (OR, 1.17; 95% CI, 1.13 to 1.21), metastatic disease (OR, 1.39; 95% CI, 1.35 to 1.41), female sex (OR, 1.17; 95% CI, 1.14 to 1.20), > one comorbidity (OR, 1.29; 95% CI, 1.25 to 1.32), and tumor type. The number of denied claims increased over time. Conclusion: Our study demonstrated a rapid decline in the percentage of patients treated with ESAs after changes to reimbursement policy, but not after warnings about use. Reimbursement restrictions of other overused or off-label drugs may help reduce health care expenditures.

Original languageEnglish (US)
Pages (from-to)264-269
Number of pages6
JournalJournal of Oncology Practice
Volume10
Issue number4
DOIs
StatePublished - Jul 1 2014

Fingerprint

Hematinics
Medicare
Odds Ratio
Logistic Models
Sex Ratio
Health Expenditures
Blood Transfusion
Ovarian Neoplasms
Colonic Neoplasms
Comorbidity
Neoplasms
Prostatic Neoplasms
Breast
Demography
Databases

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy
  • Medicine(all)

Cite this

Erythropoiesis-stimulating agent use after changes in medicare reimbursement policies. / Hershman, Dawn L.; Neugut, Alfred I.; Shim, Jin Joo; Glied, Sharon; Tsai, Wei Yann; Wright, Jason D.

In: Journal of Oncology Practice, Vol. 10, No. 4, 01.07.2014, p. 264-269.

Research output: Contribution to journalArticle

Hershman, Dawn L. ; Neugut, Alfred I. ; Shim, Jin Joo ; Glied, Sharon ; Tsai, Wei Yann ; Wright, Jason D. / Erythropoiesis-stimulating agent use after changes in medicare reimbursement policies. In: Journal of Oncology Practice. 2014 ; Vol. 10, No. 4. pp. 264-269.
@article{b49d7d38d6b1426dae5a323675de43b1,
title = "Erythropoiesis-stimulating agent use after changes in medicare reimbursement policies",
abstract = "Purpose: Since 2004, concerns about the safety of erythropoiesis-stimulating agents (ESAs) have resulted in label changes and restrictions on their use. We examined changes in ESA use and blood transfusions over time. Methods: The SEER-Medicare database was used to identify patients age ≥ 65 years with breast, lung, prostate, ovary, or colon cancer, diagnosed between 2000 and 2007, who had a chemotherapy claim after their cancer diagnosis. We calculated the mean number of ESA claims per patient per year. Follow-up claims were available through 2008. We used multivariable logistic regression models to analyze the association of ESA use and extended ESA use with clinical and demographic variables. Results: Among 121,169 patients identified, 46,063 (38{\%}) received an ESA. ESA use increased from 12.4{\%} to 16.2{\%} by 2006 and then decreased to 7.9{\%} by 2008. Similarly, the mean number of ESA claims per patient decreased steadily over the entire timeframe. The annual percentage of patients undergoing transfusion remained relatively constant (9{\%} to 10{\%}). In a Cox proportional hazards time-dependent model, ESA use was positively associated with black race (odds ratio [OR], 1.11; 95{\%} CI, 1.07 to 1.15), metropolitan location (OR, 1.17; 95{\%} CI, 1.13 to 1.21), metastatic disease (OR, 1.39; 95{\%} CI, 1.35 to 1.41), female sex (OR, 1.17; 95{\%} CI, 1.14 to 1.20), > one comorbidity (OR, 1.29; 95{\%} CI, 1.25 to 1.32), and tumor type. The number of denied claims increased over time. Conclusion: Our study demonstrated a rapid decline in the percentage of patients treated with ESAs after changes to reimbursement policy, but not after warnings about use. Reimbursement restrictions of other overused or off-label drugs may help reduce health care expenditures.",
author = "Hershman, {Dawn L.} and Neugut, {Alfred I.} and Shim, {Jin Joo} and Sharon Glied and Tsai, {Wei Yann} and Wright, {Jason D.}",
year = "2014",
month = "7",
day = "1",
doi = "10.1200/JOP.2013.001255",
language = "English (US)",
volume = "10",
pages = "264--269",
journal = "Journal of Oncology Practice",
issn = "1554-7477",
publisher = "American Society of Clinical Oncology",
number = "4",

}

TY - JOUR

T1 - Erythropoiesis-stimulating agent use after changes in medicare reimbursement policies

AU - Hershman, Dawn L.

AU - Neugut, Alfred I.

AU - Shim, Jin Joo

AU - Glied, Sharon

AU - Tsai, Wei Yann

AU - Wright, Jason D.

PY - 2014/7/1

Y1 - 2014/7/1

N2 - Purpose: Since 2004, concerns about the safety of erythropoiesis-stimulating agents (ESAs) have resulted in label changes and restrictions on their use. We examined changes in ESA use and blood transfusions over time. Methods: The SEER-Medicare database was used to identify patients age ≥ 65 years with breast, lung, prostate, ovary, or colon cancer, diagnosed between 2000 and 2007, who had a chemotherapy claim after their cancer diagnosis. We calculated the mean number of ESA claims per patient per year. Follow-up claims were available through 2008. We used multivariable logistic regression models to analyze the association of ESA use and extended ESA use with clinical and demographic variables. Results: Among 121,169 patients identified, 46,063 (38%) received an ESA. ESA use increased from 12.4% to 16.2% by 2006 and then decreased to 7.9% by 2008. Similarly, the mean number of ESA claims per patient decreased steadily over the entire timeframe. The annual percentage of patients undergoing transfusion remained relatively constant (9% to 10%). In a Cox proportional hazards time-dependent model, ESA use was positively associated with black race (odds ratio [OR], 1.11; 95% CI, 1.07 to 1.15), metropolitan location (OR, 1.17; 95% CI, 1.13 to 1.21), metastatic disease (OR, 1.39; 95% CI, 1.35 to 1.41), female sex (OR, 1.17; 95% CI, 1.14 to 1.20), > one comorbidity (OR, 1.29; 95% CI, 1.25 to 1.32), and tumor type. The number of denied claims increased over time. Conclusion: Our study demonstrated a rapid decline in the percentage of patients treated with ESAs after changes to reimbursement policy, but not after warnings about use. Reimbursement restrictions of other overused or off-label drugs may help reduce health care expenditures.

AB - Purpose: Since 2004, concerns about the safety of erythropoiesis-stimulating agents (ESAs) have resulted in label changes and restrictions on their use. We examined changes in ESA use and blood transfusions over time. Methods: The SEER-Medicare database was used to identify patients age ≥ 65 years with breast, lung, prostate, ovary, or colon cancer, diagnosed between 2000 and 2007, who had a chemotherapy claim after their cancer diagnosis. We calculated the mean number of ESA claims per patient per year. Follow-up claims were available through 2008. We used multivariable logistic regression models to analyze the association of ESA use and extended ESA use with clinical and demographic variables. Results: Among 121,169 patients identified, 46,063 (38%) received an ESA. ESA use increased from 12.4% to 16.2% by 2006 and then decreased to 7.9% by 2008. Similarly, the mean number of ESA claims per patient decreased steadily over the entire timeframe. The annual percentage of patients undergoing transfusion remained relatively constant (9% to 10%). In a Cox proportional hazards time-dependent model, ESA use was positively associated with black race (odds ratio [OR], 1.11; 95% CI, 1.07 to 1.15), metropolitan location (OR, 1.17; 95% CI, 1.13 to 1.21), metastatic disease (OR, 1.39; 95% CI, 1.35 to 1.41), female sex (OR, 1.17; 95% CI, 1.14 to 1.20), > one comorbidity (OR, 1.29; 95% CI, 1.25 to 1.32), and tumor type. The number of denied claims increased over time. Conclusion: Our study demonstrated a rapid decline in the percentage of patients treated with ESAs after changes to reimbursement policy, but not after warnings about use. Reimbursement restrictions of other overused or off-label drugs may help reduce health care expenditures.

UR - http://www.scopus.com/inward/record.url?scp=84929992606&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929992606&partnerID=8YFLogxK

U2 - 10.1200/JOP.2013.001255

DO - 10.1200/JOP.2013.001255

M3 - Article

VL - 10

SP - 264

EP - 269

JO - Journal of Oncology Practice

JF - Journal of Oncology Practice

SN - 1554-7477

IS - 4

ER -