title: Disease-related costs of care and survival among Medicare-enrolled patients with myelodysplastic syndromes.
abstract: Although newer treatments for myelodysplastic syndromes (MDS), particularly hypomethylating agents (HMAs), are expensive, it is unclear whether MDS-related costs of care are associated with overall survival. This study evaluated the relation between MDS-related costs and survival among Medicare beneficiaries with MDS.
  
  
  
  Eligible patients were identified from the Surveillance, Epidemiology, and End Results-Medicare database with codes for MDS from International Classification of Diseases for Oncology, 3rd edition. The patients were diagnosed between January 1, 2005 and December 31, 2011, were 66 years old or older, and were followed through death or the end of study (December 31, 2012). Medicare payments were used to estimate costs. Cumulative costs in a propensity score-matched group of cancer-free Medicare beneficiaries were subtracted from costs in the MDS cohort in each registry to estimate MDS-related costs. Hazard ratios (HRs) and 95% confidence intervals (CIs) were derived from multivariate Cox proportional hazards models adjusted for patient and disease characteristics.
  
  
  
  There were 8580 eligible patients, and 1,267 (14.7%) received HMAs. The overall 2-year survival rate was 48.7%, and the 2-year registry-specific MDS-related cost per patient ranged from $40,793 to $78,156 across 16 registries. The 2-year MDS-related cost was not associated with survival in the overall study population (first tertile, reference; second tertile, HR, 0.96; 95% CI, 0.89-1.04; P = .29; third tertile, HR, 0.98; 95% CI, 0.91-1.06; P = .64) or in subgroups of patients who did or did not receive HMAs.
  
  
  
  Medicare expenditures for elderly patients with MDS varied across registries but were not associated with survival. A lack of an association between costs and outcomes warrants additional research because it may help to identify potential areas for cost-saving interventions without compromising patient outcomes. Cancer 2016;122:1598-607. © 2016 American Cancer Society.
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.|Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
authors.affiliation: Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.|Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Rong
authors.initials: R
authors.lastname: Wang
authors.affiliation: Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.|Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Shuangge
authors.initials: S
authors.lastname: Ma
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Yinjun
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.|Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.|Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Ma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009190:Myelodysplastic Syndromes / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D012042:Registries; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: cost; hypomethylating agents; myelodysplastic syndromes; survival