Health care utilization and mortality among elderly patients with myelodysplastic syndromes.
BACKGROUND
Mortality in patients with myelodysplastic syndromes (MDS) is high, and patients are likely to require hospitalizations, emergency department (ED) visits, and transfusions. The relationships between these events and the MDS complications of anemia, neutropenia, and thrombocytopenia are not well understood.


METHODS
A total of 1864 patients registered in the United States' Surveillance Epidemiology and End Results (SEER) program and aged ≥ 66 years old when diagnosed with MDS in 2001 or 2002 were included. Medicare claims were used to identify MDS complications and utilization (hospitalizations, ED visits, and transfusions) until death or the end of 2005. Mortality was based on SEER data. Kaplan-Meier incidence rates were estimated and multivariable Cox models were used to study the association between complications and outcomes.


RESULTS
The 3-year incidence of anemia, neutropenia, and thrombocytopenia was 81%, 25%, and 41%, and the incidence of hospitalization, ED visit, and transfusion was 62%, 42%, and 45%, respectively. Median survival time was 22 months. Cytopenia complications were significantly associated with each of these outcomes.


CONCLUSIONS
All types of cytopenia are common among patients with MDS and are risk factors for high rates of health care utilization and mortality. Management of the complications of MDS may improve patient outcomes.
Outcomes Insights, Inc., Westlake Village.
K J
KJ
Lindquist
Outcomes Insights, Inc., Westlake Village. Electronic address: mark@outins.com.
M D
MD
Danese
Department of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale.
J
J
Mikhael
Department of Oncology/Hematology, California Pacific Medical Center, San Francisco.
K B
KB
Knopf
Outcomes Insights, Inc., Westlake Village; Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
R I
RI
Griffiths
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000401:mortality*; D009503:Neutropenia / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D016016:Proportional Hazards Models; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology