PCN73 - Economic Outcomes of Medicare Reimbursement Policy Change on Erythropoiesis-Stimulating Agents in Cancer Patients

Abstract

Centers for Medicare and Medicaid Services (CMS) issued a Medicare reimbursement policy change for erythropoiesis-stimulating agents (ESAs) in cancer patients because clinical trials found that ESAs were associated with increased risks. The economic impact of the policy change is unknown. The objective of this study is to examine economic outcomes of Medicare reimbursement policy change in cancer patients using ESAs. In this study, the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database was used. The study design was a retrospective incident user cohort design. Economic outcomes were measured by anemia-related costs and total medical costs. The treatment group was composed of cancer patients and the control group was composed of chronic kidney disease (CKD) patients. A difference-in-difference (DID) design was used to examine economic outcomes of the policy change. A generalized linear model (GLM) with a log link and a gamma distribution was used in the analysis. In the treatment group, we identified 17,382 incident users of ESAs in the pre-policy period and 4,490 in the post-policy period. In the control group, we identified 3,069 incident users of ESAs in the pre-policy period and 1,306 in the post-policy period. After controlling for covariates, the policy change was associated with a 11.20% (P=.0113) reduction in anemia-related costs and a 11.96% (P=.0001) reduction in total medical costs. Specifically, in anemia-related costs, Medicare payment was reduced by 9.83% (P=.0310) and patient cost-sharing was reduced by 18.40% (P<.0001). In total medical costs, Medicare payment was reduced by 11.59% (P=.0003) and patient cost-sharing was reduced by 13.58% (P<.0001). Medicare reimbursement policy change reduced anemia-related costs and total medical costs in cancer patients using ESAs. The policy change was effective in reducing expenditures in CMS and patients.