title: Use of and spending on supportive care medications among Medicare beneficiaries with cancer.
abstract: OBJECTIVE
  The study objective was to provide population-based estimates of supportive care medication (SCM) use among Medicare beneficiaries with cancer and determine factors related to SCM receipt.
  
  
  METHODS
  This retrospective cohort study of community-based Medicare beneficiaries used the Medicare Current Beneficiary Survey (1997–2007). Dependent variables comprised use and spending on SCMs for three medication classes: opioids, antidepressants/sedative/hypnotics (ASH), and antiemetics. Independent variables of interest were supplemental insurance coverage, cancer site, and treatment. Multivariate models determined factors affecting receipt of, and spending on, SCMs. We also compared SCM use and spending among beneficiaries with and without cancer in order to understand what portion of SCM use and spending could be attributed to cancer as opposed to other comorbid conditions.
  
  
  RESULTS
  A total of 1,836 Medicare beneficiaries with cancer and 9,898 beneficiaries without cancer were eligible for the study. Beneficiaries with cancer were more likely to receive opioids, ASH, and antiemetics compared to non-cancer beneficiaries. Adjusted annual payments for antiemetics were on average $637 higher in with cancer versus without cancer (p<0.01), while ASH payments were $184 lower (p<0.01). Opioid spending was similar among cancer and non-cancer users. Relative to colon cancer, beneficiaries with prostate cancer were least likely to receive any of the three SCM classes. Receipt of antineoplastic treatment increased the probability of use of all three classes of SCMs. Insurance coverage did not influence the use of or spending on opioids or antiemetics, but was associated with both outcomes for ASH. The use of all three SCM classes was significantly lower during years before Part D implementation of the new Medicare Part D prescription drug benefit and was higher after implementation of Part D.
  
  
  CONCLUSIONS
  This study provides population-based information on SCM use among Medicare beneficiaries with cancer. Cancer site and treatment modality were important predictors of SCM use.
authors.forename: Ilene H
authors.initials: IH
authors.lastname: Zuckerman
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.forename: Mujde Z
authors.initials: MZ
authors.lastname: Erten
authors.forename: Bruce
authors.initials: B
authors.lastname: Stuart
authors.forename: Thomas
authors.initials: T
authors.lastname: Shaffer
authors.forename: J Samantha
authors.initials: JS
authors.lastname: Dougherty
authors.forename: Candice
authors.initials: C
authors.lastname: Yong
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000191:economics; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D010166:Palliative Care / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives