Relationship between age and health care utilization in patients with myelodysplastic syndrome receiving supportive care.

Abstract

6560 Background: Myelodysplastic syndrome (MDS) is rare in people under 50. Little is known about the disease in this group, particularly among those patients who receive supportive care only. Methods: This was a descriptive cohort study using a large commercial claims database. The study included patients with an initial MDS claim (ICD-9-CM 238.72-238.75) between 2/1/2007 and 7/31/2008, who were continuously enrolled for 6 months prior to and 12 months following the index claim. Patients were excluded it they were treated with either hypomethylating agents (HMA) or thalidomide analogues (TA). Once identified, patients were stratified into two group, those aged <50 and those ≥50. Demographic variables and utilization and costs were calculated in the pre- and postindex period, respectively. Results: The study identified 1,209 patients newly diagnosed with MDS and continuously enrolled in the health plan. After excluding 76 (6.3%) who were treated with HMA/TA, the final cohort contained 1,133 patients. Of these, 221 (19.5%) were <50 and 912 (80.5%) were ≥50. In the first year after diagnosis, patients <50 had significantly fewer office visits than the older group (17.5 vs. 24.2, p<.001) but were no different in the proportion hospitalized (25.8% vs. 29.2%, respectively, p=.52) or in length of stay (7.8 vs. 9.0 days, p=.42). Mean total health care charges were $30,177 (SD $53,550, Md $9,622) for patients <50 and $31,832 (SD $63,658, Md $12,248) for those ≥ 50 (p=.69). Conclusions: Despite MDS being classified as a disease of the elderly, the results showed that among the commercially insured, 1 in 5 diagnosed with MDS was under 50. Although NCCN guidelines support HMA treatment, the vast majority received supportive care only. In addition, for both age groups, hospitalizations were common, and total healthcare costs were high but did not differ between the two groups. This suggests similar levels of diseases severity. Further studies of the characteristics of patients with early onset MDS appear warranted.