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Use and Spending on Antineoplastic Therapy for Medicare Beneficiaries With Cancer

Davidoff, Amy J. PhD*,†,‡; Shaffer, Thomas MHS*,‡; Erten, Mujde Z. PhD*,‡; Shoemaker, J. Samantha BA, PhD*; Zuckerman, Ilene H. PharmD, PhD*,‡; Pandya, Naimish MD; Stuart, Bruce C. PhD*,‡; Bryant-Comstock, Lynda G. MA, MS§; Shenolikar, Rahul PhD§

doi: 10.1097/MLR.0b013e3182726ceb
Original Articles

Background: Oral antineoplastic drugs, not generally covered by Medicare Part B, have assumed an increasingly important role in cancer treatment.

Objective: We examined use and spending on infused/injected (Part B covered) and non-Part B antineoplastic agents in a Medicare beneficiary population with cancer, and the effect of supplemental insurance.

Research Design: This retrospective, observational study used pooled 1997–2007 data from the Medicare Current Beneficiary Survey, linked to Medicare claims. Logistic regression models identified factors associated with antineoplastic use. Generalized linear models were used to estimate spending among antineoplastic users. Population studied: A total of 1836 Medicare beneficiaries with newly diagnosed cancer were selected based on the presence of claims-based diagnoses after a 12-month washout period.

Results: Five hundred fifty-nine (31.0%) Medicare beneficiaries received antineoplastic therapy; 395 (21.3%) used Part B, 253 (14.6%) used non-Part B antineoplastics. Spending per user was $7841 (any), $10,364 (Part B), and $1535 for non-Part B antineoplastics. Supplemental insurance was associated with antineoplastic use. Primary cancer site and age were key predictors of spending among users. Spending on non-Part B antineoplastics increased during 2006–2007 relative to 2004–2005 but time trends were not significant in multivariate analysis.

Conclusions: Antineoplastic therapy use by Medicare beneficiaries is sensitive to the presence but not type of supplemental insurance. Non-Part B therapy was used by a relatively large proportion of beneficiaries with cancer receiving therapy, although spending was less than for Part B therapy. Monitoring the role of supplemental insurance, and particularly the role of Medicare Part D is a critical area for ongoing research.

*Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy

University of Maryland Greenebaum Cancer Center

Peter Lamy Center on Drug Therapy and Aging, Baltimore, MD

§GlaxoSmithKline, Durham, NC

The authors declare no conflict of interest.

A.J.D., T.S., B.C.S., J.S.S., and N.P. received support through a contract from Glaxo-Smith-Kline. A.J.D., B.C.S., N.P., and I.H.Z. received research support through a grant from the American Cancer Society (RSGI-1 0-1 09-0 1-CPHPS). L.G.B-C. and R.S. are employees of Glaxo-Smith-Kline and own GSK stock. This work was also supported by Candice Yong, Pharmaceutical Health Services Research Department.

Reprints: Amy J. Davidoff, PhD, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 01-214, Baltimore, MD 21201. E-mail:

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