title: Benefits Improvement and Protection Act's impact on transplantation rates among elderly MEDICARE beneficiaries with end-stage renal disease.
abstract: BACKGROUND
  The Benefits Improvement and Protection Act (BIPA) expanded Medicare coverage for posttransplantation immunosuppresants for elderly patients and others eligible for Medicare beyond their end-stage renal disease (ESRD) status yet retained the 3-year limit for patients eligible solely because of ESRD status. Our objective was to determine BIPA's impact on renal transplantation among elderly patients (age ≥65 years) affected by BIPA.
  
  
  METHODS
  Medicare claims and the U.S. Renal Data System Standard Analysis Files were used to analyze the likelihood of transplantation among elderly patients, all of whom were affected by BIPA, versus the nonelderly, many of whom were unaffected by BIPA. A difference-in-differences approach and generalized logistic regressions were used to estimate BIPA's impact.
  
  
  RESULTS
  Analysis of data for 632,904 ESRD Medicare beneficiaries who met inclusion/exclusion criteria suggests that BIPA made elderly patients more likely (relative likelihood, 1.36; 95% confidence interval, 1.32-1.41) to have a transplant. The likelihood for nonelderly patients decreased following BIPA (relative likelihood, 0.93; 95% confidence interval, 0.92-0.94).
  
  
  CONCLUSIONS
  Transplantation rates increased among those elderly patients, all of whom were affected by BIPA by extending immunosuppressant coverage under BIPA. These results suggest that removing financial barriers to posttransplantation care may positively impact transplantation rates yet raise questions regarding whether the law shifted transplants from younger to older patients.
authors: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA. dmullins@rx.umaryland.edu
authors: C Daniel
authors: CD
authors: Mullins
authors: Rahul
authors: R
authors: Jain
authors: Matthew R
authors: MR
authors: Weir
authors: Christine S
authors: CS
authors: Franey
authors: Ya-Chen Tina
authors: YC
authors: Shih
authors: Françoise G
authors: FG
authors: Pradel
authors: Kaloyan
authors: K
authors: Bikov
authors: Stephen T
authors: ST
authors: Bartlett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D019458:Insurance Coverage / Q000191:economics; D007676:Kidney Failure, Chronic / Q000191:economics / Q000601:surgery*; D016030:Kidney Transplantation / Q000191:economics / Q000706:statistics & numerical data*; D007878:Legislation as Topic / Q000191:economics*; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics*; D012189:Retrospective Studies; D014481:United States