Increasing Use of Tumor Necrosis Factor-Alpha Inhibitors Among Medicare Beneficiaries Despite Known Increased Risk of Nonmelanoma Skin Cancer.

BACKGROUND

Tumor necrosis factor-alpha inhibitors (TNFis) are associated with an increased risk of nonmelanoma skin cancer (NMSC). NMSC rates, at baseline, are highest among elderly patients. There are limited data on the use of TNFis in elderly Americans.

OBJECTIVE

This study evaluates trends in use of TNFis among Medicare patients and estimates the NMSC burden attributable to TNFi use.

METHODS

A retrospective cohort study was performed using Medicare Part B and D public data sets.

RESULTS

The number of TNFi beneficiaries increased by 8.0% between 2019 and 2023 and spending increased by 37.5%. Beneficiaries aged 65 years and older accounted for 51.7% of all TNFi claims in 2023 compared with 45.2% in 2019. The most common prescriber specialty was rheumatology (60.5% of claims); dermatology accounted for 6.8% of claims. We estimate that there were up to 5,743 TNFi-associated NMSCs in Medicare patients in 2023.

CONCLUSION

The use of TNFis in elderly Medicare beneficiaries increased despite evidence of increased risk of NMSCs. Ongoing TNFi use may contribute to excess cases of NMSC in the Medicare population.