title: Cost-related medication nonadherence and cost-saving strategies used by elderly Medicare cancer survivors.
abstract: OBJECTIVE
  This study was conducted to compare cost-related medication nonadherence among elderly Medicare enrollees with and without cancer and to describe the strategies cancer survivors used to offset the costs of medications.
  
  
  METHODS
  Using the 2005 Medicare Current Beneficiary Survey and Medicare claims, we compared self-reported cost-related medication nonadherence (CRN), spending less on basic needs to afford medicines, and cost reduction strategies among elderly beneficiaries with and without cancer. Descriptive statistics and logistic regression models were used to characterize and compare these populations.
  
  
  RESULTS
  In a nationally representative sample of 9,818 non-institutionalized elderly Medicare enrollees, 1,392 (14%) were classified as cancer survivors based on Medicare claims. Cancer survivors were older, more highly educated, more likely to be male and non-Hispanic, and more likely to have multiple comorbidities, poorer health status, and employer-paid medication coverage. While 10% of cancer survivors and 11% without cancer reported CRN, about 6% and 9% (p = 0.004) of those with and without cancer, respectively, reported spending less on basic needs to offset the costs of medications. Cancer survivors who reported CRN (n = 143) had lower income (62.2% versus 48.6%, p = 0.11) and were more likely to be African-American (13.0% versus 6.4%, p = 0.033) and have non-employer-based medication insurance (p = 0.002) compared to those who did not report CRN. In adjusted analyses, CRN among the two groups was similar, but with some subgroup differences noted by gender and cancer type. Use of cost reduction strategies was mostly similar among cancer survivors and those without cancer.
  
  
  CONCLUSIONS
  Cost-related medication nonadherence medication is common among elderly Medicare beneficiaries, but appears to be similar among those with and without cancer.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA. larissa_nekhlyudov@harvardpilgrim.org
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Jeanne
authors.initials: J
authors.lastname: Madden
authors.forename: Amy Johnson
authors.initials: AJ
authors.lastname: Graves
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008489:Medical Indigency / Q000523:psychology*; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology*; D009369:Neoplasms / Q000191:economics* / Q000401:mortality / Q000523:psychology*; D011379:Prognosis; D015996:Survival Rate; D017741:Survivors / Q000523:psychology*; D014481:United States