title: Use and spending on antineoplastic therapy for Medicare beneficiaries with cancer.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA. adavidof@rx.umaryland.edu
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.forename: Thomas
authors.initials: T
authors.lastname: Shaffer
authors.forename: Mujde Z
authors.initials: MZ
authors.lastname: Erten
authors.forename: J Samantha
authors.initials: JS
authors.lastname: Shoemaker
authors.forename: Ilene H
authors.initials: IH
authors.lastname: Zuckerman
authors.forename: Naimish
authors.initials: N
authors.lastname: Pandya
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Stuart
authors.forename: Lynda G
authors.initials: LG
authors.lastname: Bryant-Comstock
authors.forename: Rahul
authors.initials: R
authors.lastname: Shenolikar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D005382:Financing, Personal / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data*; D054524:Medicare Part D / Q000191:economics*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000970:Antineoplastic Agents