Assessment of performance measures for patients with the myelodysplastic syndrome (MDS) in the United States.

Abstract

6002 Background: Although baseline bone marrow examination and assessment of iron stores before initiating an erythropoiesis-stimulating agent (ESA) are nationally endorsed performance measures for patients with MDS, it is not known to what extent clinicians adhere to them. Methods: We used the SEER-Medicare database to identify Medicare enrollees diagnosed with MDS from 2001-2005. Inpatient and outpatient claims through 2007 were analyzed for evidence of bone marrow examination, iron assessment (bone marrow iron stain, or serum ferritin, iron or transferrin), erythropoietin level, and ESA use through CPT, HCPCS, and ICD-9 procedure codes. Descriptive statistics were performed, and multivariable logistic regression was used to characterize covariates. Results: 6753 MDS patients met eligibility criteria. Median age at diagnosis was 79.8 (IQR 74.6-84.5); 45.0% were female. 5495 subjects (81.4%) had a claim for bone marrow biopsy within 3 months before to 3 months after their SEER diagnosis date. 4,108 (60.8%) had at least one claim for an ESA during the study period; of those, 1,754 (42.7%) had evidence of iron assessment within 3 months before their first ESA treatment, and 839 (20.4%) had pre-ESA assessment of erythropoietin level. In a multivariable model, age < 75 (OR 1.66 [1.42- 1.94]), metropolitan residence (OR 1.41 [1.18-1.68]), being married (OR 1.22 [1.07-1.38]), residence in the Midwest (OR 1.38 [1.12-1.70]), and highest vs. lowest socioeconomic quintile based on census tract (OR 1.42 [1.16-1.75]) were associated with bone marrow examination (p < 0.005 for all); notably, year of diagnosis and Charlson Comorbidity Score were not. There were no multivariable associations with pre-ESA iron assessment, except for residence in the West (OR 1.26 [1.07-1.49]). Conclusions: The majority of patients in our cohort received baseline bone marrow examination, although performance varied with several nonclinical characteristics. In contrast, less than half of patients undergoing ESA treatment had evidence of pretreatment assessment of iron status, and even fewer of pretreatment erythropoietin assessment. Given the high cost of ESA therapy, these findings may have important policy implications. No significant financial relationships to disclose.