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A decision exercise to engage cancer patients and families in deliberation about Medicare coverage for advanced cancer care.

BackgroundConcerns about unsustainable costs in the US Medicare program loom as the number of retirees increase and experiences serious and costly illnesses like cancer. Engagement of stakeholders, particularly cancer patients and their families, in prioritizing insured services offers a valuable strategy for informing Medicare coverage policy. We designed and evaluated a decision exercise that allowed cancer patients and family members to choose Medicare benefits for advanced cancer patients.MethodsThe decision tool, Choosing Health plans All Together (CHAT) was modified to select services fo

Diagnostic imaging for spinal disorders in the elderly: a narrative review.

The high prevalence of neck and low back pain in the rapidly aging population is associated with significant increases in health care expenditure. While spinal imaging can be useful to identify less common causes of neck and back pain, overuse and misuse of imaging services has been widely reported. This narrative review aims to provide primary care providers with an overview of available imaging studies with associated potential benefits, adverse effects, and costs for the evaluation of neck and back pain disorders in the elderly population. While the prevalence of arthritis and degenerative

Enhancing medication adherence with blister-packed oral oncolytics: A case example in chronic lymphocytic leukemia.

IntroductionMedication nonadherence is a prevalent issue in the oncology population and can be costly on the healthcare system while leading to worsened outcomes, including increased mortality. One intervention that has been shown to help promote medication adherence to oral therapies for chronic conditions is blister-packaging. However, no literature is available assessing the potential impact of blister-packaging in oncology. Therefore, we aimed to quantify the impact of blister-packaging oral oncolytics on medication adherence and healthcare costs.MethodsAn economic model was designed to as

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… Part D cost sharing structure which can see OOP cost exceed $10,000 per patient for oral oncolytics. 60 However, starting in 2025 OOP costs will be capped at $2000 per Medicare Part D beneficiary due to the Inflation Reduction Act, 61 which may help reduce the occurrence of cost-related nonadherence … Estimating 2019 out-of-pocket cost of oral medications for metastatic renal cell carcinoma for medicare part D members. Oncolytics Today 2019 Fall; 1: 14–16. 61. Kaiser Family Foundation. An overview of the medicare part d prescription drug benefit. …

Cost-Effectiveness Analysis of Adding Daratumumab to Bortezomib, Melphalan, and Prednisone for Untreated Multiple Myeloma.

Background: To evaluate the cost-effectiveness of adding daratumumab to bortezomib, melphalan, and prednisone for transplant-ineligible newly diagnosed multiple myeloma patients. Methods: A three-state Markov model was developed from the perspective of US payers to simulate the disease development of patient's life time for daratumumab plus bortezomib, melphalan, and prednisone (D-VMP) and bortezomib, melphalan, and prednisone (VMP) regimens. The primary outputs were total costs, expected life-years (LYs), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). R

Реальные модели лечения и результаты лечения пациентов с множественной миеломой, инициирующих эгранатамаб: результаты ALTITUDE-1 и ALTITUDE-2 Ретроспективные когортные исследования.

AIM: Elranatamab в настоящее время является антителом с биенной спецификой, утвержденным в Соединенных Штатах (США) для лечения повторной/охлажденной множественной миеломы (ММ). С учетом его недавнего одобрения реальные данные являются ограниченными. МЕТОДЫ: РЕЗУЛЬТАТЫ РАБОТЫ two исследования реального мира (РВ) с использованием административных требований (см.ALTITUDE-1) и данные о плате за услуги (ALTITUDE-2) сообща сообщаются здесь. Американские пациенты с MM, которые запустили Elranatamab после августа 2023 в сентябре/октябре 2025. Сообщалось о характеристиках пациентов, клинической истори

Patient perspectives on BCMA-targeted therapies for multiple myeloma: a survey conducted in a patient advocacy group.

BackgroundAdvances in multiple myeloma (MM) treatment have shifted the therapeutic landscape. Understanding patients' perspectives can assist physicians in helping patients make informed decisions. This study aimed to understand the patient decision-making process and gain insights into patient perspectives on B-cell maturation antigen (BCMA)-targeted therapies for MM.MethodsAn 18-question survey was completed by patients with MM enrolled in HealthTree® Cure Hub, an online portal helping patients with plasma cell dyscrasias navigate their disease.ResultsFrom October 28, 2022, to January 12, 20

Dynamic frailty risk assessment among older adults with multiple myeloma: A population-based cohort study.

Multiple myeloma (MM) is a cancer of older adults and those who are more frail are at high risk of poor outcomes. Current tools for identifying and categorizing frail patients are often static and measured only at the time of diagnosis. The concept of dynamic frailty (i.e. frailty changing over time) is largely unexplored in MM. In our study, adults with newly-diagnosed MM who received novel drugs between the years 2007-2014 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Using a previously published cumulative deficit approach, a frailty in

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… Patients without Medicare Part D (prescription) for the 12 months post diagnosis were also excluded as MM treatment could not be ascertained. Variables Frailty was defined according to a previously validated frailty index based on the cumulative deficit definition [ 17 ]. …

Longitudinal patterns of cancer patient reported outcomes in end of life care predict survival.

PurposePatients with advanced cancer typically demonstrate sharp deterioration in physical function and psychological status during the last months of life. This study evaluates the relationship between survival in patients with advanced cancer and longitudinal assessment of anxiety, depression, fatigue, pain interference, and/or physical function using the US National Institute of Health Patient Reported Outcomes Information System.MethodsMixed-effects models were used to evaluate patient-reported outcome trajectories over time among patients with advanced loco-regional or metastatic cancer r

The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival.

This article presents a detailed account of the incidence, prevalence, and survival experience of people with end-stage renal disease (ESRD) covered by Medicare. The number of new entrants into the ESRD program has risen since its inception. This increase is greatest for people whose cause of renal failure is primary hypertensive disease or diabetic nephropathy. The program incidence rates for black people is 2.8 times that of white people. Incidence is highest for persons 65 to 69 years of age. Total patient survival is 44 percent 5 years after renal failure onset. Total Medicare enrollment f

Real-World Characteristics, Treatment Patterns, Health Care Resource Use, and Costs of Patients with Diffuse Large B-Cell Lymphoma in the U.S.

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of non-Hodgkin lymphoma in the U.S., but current real-world data are limited. This study was conducted to describe real-world characteristics, treatment patterns, health care resource utilization (HRU), and health care costs of patients with treated DLBCL in the U.S. MATERIALS AND METHODS: A retrospective study was conducted using the Optum Clinformatics Data Mart database (January 2013 to March 2018). Patients with an International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis f

Precancer and cancer-associated depression and anxiety among older adults with blood cancers in the United States.

For patients with blood cancers, comorbid mental health disorders at diagnosis likely affect the entire disease trajectory, as they can interfere with disease information processing, lead to poor coping, and even cause delays in care. We aimed to characterize the prevalence of depression and anxiety in patients with blood cancers. Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients ≥67 years old diagnosed with lymphoma, myeloma, leukemia, or myelodysplastic syndromes between 2000 and 2015. We determined the prevalence of precancer depression and anxi

Factors determining utilization of stem cell transplant for initial therapy of multiple myeloma by patient race: exploring intra-racial healthcare disparities.

Multiple myeloma (MM) therapeutics have evolved tremendously in recent years, with significant improvement in patient outcomes. As newer treatment options are developed, stem cell transplant (SCT) remains an important modality that provides excellent disease control and delays the progression of disease. Over the years, SCT use has increased overall in the U.S., but two distinct gaps remain, including suboptimal use overall and racial-ethnic disparities. We evaluated the National Cancer Database (NCDB) to study what sociodemographic factors might play a role within a given racial-ethnic group

Patient Perspectives on Health Insurance Design: A Mixed-Methods Analysis.

There remains a persistent lack of patient-centered evidence on insurance reform and real-world experiences of patients with chronic disease. This study gathered insights around insurance design from chronic disease beneficiaries. This mixed-methods analysis comprised an online survey and virtual focus group sessions (August to December 2023) involving US residents with chronic disease and health insurance. Patients' perspectives on insurance design were explored. Survey data were analyzed descriptively. Key themes were identified from focus group transcripts and direct observations. In total,

Budget Impact of Belantamab Mafodotin (Belamaf) Adoption in the Treatment of Patients with Relapsed or Refractory Multiple Myeloma in the United States.

PURPOSE: Estimate the budget impact of belantamab mafodotin (belamaf) for patients with relapsed/refractory multiple myeloma (RRMM) who have received ≥4 prior therapies, including an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent. METHODS: A budget impact analysis (BIA) was developed to estimate the cost difference between current (no belamaf) and projected (with belamaf) market scenarios over 3 years. Comparators were identified from a systematic literature review and included selinexor + dexamethasone or best supportive care. The number of treatment-eli

Real-world Data on Risk Factors for Emergency Department Visits to Treat Outpatient Chemotherapy-Associated Toxicities.

UNLABELLED: The Centers for Medicare & Medicaid Services Hospital Outpatient Quality Reporting Program's OP-35 rule penalizes health systems that have a higher-than-expected rate of emergency department (ED) visits or inpatient admissions for 10 potentially preventable conditions within 30 days of receiving chemotherapy. Identifying patients at risk for toxicities and resultant acute care could lead to reducing the rate of such events, improving patient care, and reducing costs. We identified patients with cancer seen in the ED at our institution between January 1, 2018, and December 31, 2021,

Meaningful changes in end-of-life care among patients with myeloma.

Patients with advanced myeloma experience a high symptom burden particularly near the end of life, making timely hospice use crucial. Little is known about the quality and determinants of end-of-life care for this population, including whether potential increases in hospice use are also accompanied by "late" enrollment (≤ 3 days before death). Using the Surveillance, Epidemiology, and End-Results-Medicare database, we identified patients ≥ 65 years diagnosed with myeloma between 2000 and 2013 who died by December 31, 2013. We assessed prevalence and trends in hospice use, including late enroll

National survey of patient perspectives on cost discussions among recipients of copay assistance.

BackgroundIndividuals with cancer and other medical conditions often experience financial concerns from high costs-of-care and may utilize copay assistance programs (CAP). We sought to describe CAP recipients' experiences/preferences for cost discussions with clinicians.MethodsWe conducted a national, cross-sectional electronic-survey from 10/2022 to 11/2022 of CAP recipients with cancer or autoimmune conditions to assess patient perspectives on cost discussions. We used multivariable logistic regression models to explore associations of patient perspectives on cost discussions with patient ch

The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review.

BackgroundOut-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care.MethodsA systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where

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… Medication discontinuation and reinitiation among Medicare part D beneficiaries taking costly medications. Am. J. Pharm. Benefits. 2011;3:e102–e110. 44. Collins D.C., Coghlan M., Hennessy B.T., Grogan L., Morris P.G., Breathnach O.S. … High Cost Sharing and Specialty Drug Initiation Under Medicare Part D: A Case Study in Patients With Newly Diagnosed Chronic Myeloid Leukemia. Am. J. Manag. Care. 2016;22:S78–S86. 51. Dumont S., Jacobs P., Turcotte V., Turcotte S., Johnston G. …

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature.

ObjectivesPublished research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks.MethodsThe scoping review method was used because currently published research in disparities in palliative and hospice cares as well as adva

Disparities in survival of hematologic malignancies in the context of social determinants of health: a systematic review.

Social determinants of health (SDHs) have been reported as relevant factors responsible for health inequity. We sought to assess clinical data from observational studies conducted in the United States evaluating the impact of SDHs on the outcomes of patients with hematologic malignancies. Thus, we performed a systematic review in 6 databases on 1 September 2021, in which paired reviewers independently screened studies and included data from 41 studies. We assessed the risk of bias using the Joanna Briggs Institute appraisal tools and analyzed the data using a descriptive synthesis. The most co