Changes in RBC supportive medications and transfusions in cancer patients undergoing chemotherapy before and after FDA and Medicare actions in 2007

Abstract

20595 Background: In 2007, changes occurred to restrict the use and reimbursement of RBC supportive medications in cancer patients through the FDA and Medicare National Coverage (NCD) Decision. This study was designed to evaluate the use of RBC supportive medications and transfusions over a 12 month period when these changes were occurring and to compare Medicare-insured patients against non-Medicare patients undergoing chemotherapy. Methods: Demographics, outpatient nursing chemotherapy and support administration records, and labs were abstracted from the UCLA oncology electronic medical record system from November 1, 2006 to October 31, 2007. For at-risk patients (undergoing chemotherapy with a hemoglobin <12 g/dL), monthly total use of RBC transfusions and the administration of either darbepoetin or epoetin alpha was tabulated. Utilization was standardized over the monthly number of patients at risk and compared month by month. In addition, utilization was aggregated into 3 time periods (P1–3): Nov06 to Feb07 (P1, Baseline), Mar07 to July07 (P2, Post FDA label changes), and Aug07-Oct07 (P3, Post NCD decision). Subgroup analysis was performed based on insurance type. Results: A total of 56,651 patient-visits were evaluated across the university oncology clinic and 3 academically affiliated community clinics. The data represented 10,167 total patients, of which 1,444 were on active chemotherapy. Utilization of RBC transfusions per at risk patient was 0.244 in P1, 0.237 in P2, and 0.277 in P3. Utilization of RBC support medication per patient at risk was 0.418 in P1, 0.203 in P2 (P<0.01), 0.155 in P3 (P<0.05). In Medicare patients, there was an increase in the utilization of transfusions per at risk patient in P2, 0.311, as compared to P3, 0.392 (P=0.05). Utilization of both RBC transfusions and medications was significantly greater in Medicare patients compared to non-Medicare patients across all periods (p=0.02). Conclusions: There has been a overall decrease in the use of RBC support medication in cancer patients undergoing chemotherapy since the FDA label change. In Medicare patients, the use of transfusions increased during the period following the NCD decision. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen Amgen