Trends in Antiretroviral Regimen Complexity Among Medicare Beneficiaries With HIV, 2014-2018

Abstract Little is known about antiretroviral therapy (ART) patterns among Medicare beneficiaries with Human Immunodeficiency Virus (HIV). ART has significant implications for spending in Medicare Part D as use of single-tablet regimens (STR) grows, generic availability remains low, and price increases for branded therapies consistently exceed inflation. The objective of this study is to detail patterns of STR utilization among Medicare beneficiaries with HIV. We conducted a retrospective trend analysis using a 5% sample of Medicare Chronic Conditions Data Warehouse, 2014-2018. We included each person-month that fee-for-service beneficiaries with HIV had Parts A, B, and D coverage. Trends in annual prevalence of STR overall, by ART class, and by age, sex, and race subgroups were estimated. The study included 9,509 beneficiaries who contributed 345,708 person-months to the analysis. The prevalence of STR increased from 21.8% (95%CI, 21.5-22.1) in 2014 to 44.6% (95%CI, 44.3-45.0) in 2018 (p <0.0001), an increase of 104.6%. Integrase strand transfer inhibitors (INSTI) saw the largest increase in utilization between 2014 (4.4% [95%CI 4.2-4.5]) and 2018 (35.1% [95%CI 34.8-35.4]) (p<0.0001), a 701.8% increase. All sociodemographic subgroups experienced similar growth in STR use between 2014 and 2018. STR and INSTI utilization increased significantly over the study period, suggesting increased ART spending under Part D. Although increasing availability of generic multi-tablet ART regimens (MTR) may offer cost-savings, further research is needed comparing generic MTR to branded STR with regards to patient preferences, adherence, healthcare resource utilization, and total costs in the growing population of Medicare beneficiaries with HIV.

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Impact of Length of Hospice on Spending and Utilization Among Medicare Beneficiaries With Lung Cancer

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120909304 ◽

2020 ◽

Vol 37 (11) ◽

pp. 918-924

Author(s):

Yamini Kalidindi ◽

Jeah Jung ◽

Joel Segel ◽

Douglas Leslie

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Cost Savings ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Outpatient Services ◽

Lung Cancer Patients ◽

Ed Visits ◽

Aggressive Care ◽

Therapy Sessions

Objectives: To estimate differences in spending and utilization between hospice users and non-users with lung cancer by length of hospice enrollment. Study Design: Retrospective analysis using 2009-2013 Medicare claims. Methods: The study sample was a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013. We identified different categories of hospice users (hospice enrollment for 1-7 days, 8-14 days, 15-30 days, 31-60 days, 61 days – 6 months) and non-users. We used propensity score matching to match users in each enrollment category with non-users. The outcomes were: a) total Medicare spending, b) number of hospitalizations, c) number of emergency department (ED) visits, d) number of physician-administered chemotherapy claims, and e) number of radiation therapy sessions. Regression analysis was used to compare outcomes between users and non-users by enrollment period. Results: Hospice users had significantly lower spending, fewer hospitalizations, and fewer ED visits than non-users across all categories of hospice enrollment. Large savings occurred when patients stayed in hospice for at least one month (US$16,566 for those enrolled 61 days – 6 months; US$16,409 for those enrolled 31-60 days). Significant reduction in use of outpatient services including chemotherapy and radiation therapy was observed among patients using hospice for at least 1 month. Conclusions: Hospice led to cost savings by reducing utilization of aggressive care towards end-of-life among lung cancer patients. While cost savings were realized even when hospice is utilized for a short duration, large savings occurred when hospice is used for at least 1 month.

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Abstract P634: Contemporary Trends of Oral Anticoagulant Utilization Among Texas Medicare Beneficiaries With Atrial Fibrillation

Stroke ◽

10.1161/str.52.suppl_1.p634 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Youngran Kim ◽

Trudy Krause ◽

Edip Gurol ◽

Louise D McCullough ◽

Farhaan S Vahidy

Keyword(s):

Atrial Fibrillation ◽

Renal Function ◽

Claims Data ◽

Medicare Part D ◽

P Value ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Part D ◽

Medical Claims ◽

Increasing Trends

Introductions: Underutilization of oral anticoagulation (OAC) drugs among atrial fibrillation (AF) patients has been reported. We provide contemporary trends for utilization of warfarin and novel OACs (NOACs) among Medicare beneficiaries with AF in Texas. Methods: Using Texas Medicare Fee-for-Service claims data for 2014-2017, AF patients were identified if they had at least one inpatient or two outpatient claims with a diagnosis of AF using ICD 9/10 codes. AF patients having any medical claims with ICD 9/10 or CPT codes indicating vulvar stenosis or the presence of valve replacement were excluded. OACs included warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban and the use of a drug was assumed if the prescription was filled. The percentage of patients on OAC among AF patients, who were enrolled in Medicare Part D in the measurement year were reported with 95% CI and p-value for trends both overall and by CHA 2 DS 2 -VASc score and renal function. Results: Of 216,602 AF patients, 57% did not receive any OAC during any measurement year. Overall OAC utilization increased from 35.8% (35.4-36.2) in 2014 to 41.6 % (41.3-41.8) in 2017 (p <0.001). This increase was driven by NOAC use which increased from 18.6% (18.3-18.9) in 2014 to 29.3% (29.0-29.5) in 2017 (p <0.001) while the proportion of warfarin users decreased from 17.2% (16.9-17.5) in 2014 to 12.3% (12.1-12.5) in 2017 (p <0.001). Increasing trends for NOAC use and decreasing trends for warfarin were observed regardless of CHA 2 DS 2 -VASc scores and levels of renal function. Conclusions: The OAC use has been increasing but about 6 out of 10 AF patients do not receive OAC despite high CHA 2 DS 2 -VASc scores. Targeted strategies are required to address OAC underutilization among AF patients.

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People with Colorectal Cancer in SEER-Medicare: Part D Uptake, Costs, and Outcomes

10.3768/rtipress.2020.rr.0037.2005 ◽

2020 ◽

Author(s):

Lisa M. Lines ◽

Florence K. L. Tangka ◽

Sonja Hoover ◽

Sujha Subramanian

Keyword(s):

Colorectal Cancer ◽

Prescription Drug ◽

Drug Costs ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Limited Information ◽

Part D ◽

Complete Part ◽

Significant Difference ◽

Prescription Drug Costs

Limited information exists about enrollment in Part D prescription coverage by Medicare beneficiaries with cancer. Part D coverage may increase access to medicines. This study evaluated patterns of Part D uptake and costs and assessed the effects of coverage on hospitalizations and emergency department (ED) use among people with colorectal cancer (CRC). We analyzed Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data on fee-for-service (FFS) Medicare beneficiaries with at least 36 months of follow-up who were diagnosed with CRC at any point from January 2007 through December 2010, and a matched cohort of beneficiaries without cancer. Dual (Medicare/Medicaid) enrollees were excluded because they are automatically enrolled in Part D. Among beneficiaries with CRC (n=12,774), 39 percent had complete Part D coverage, defined as coverage in the diagnosis year and 2 subsequent years; the rate was 38 percent in the matched comparison cohort (P=.119). Among those with complete Part D coverage, there was no significant difference in annual prescription drug costs between people with CRC ($3,157, 95% confidence interval [CI]: $3,098–$3,216) and without ($3,113, 95% CI: $3,054–$3,172). Among people with CRC, odds of ED use ranged from unchanged to marginally higher for those with no or partial Part D coverage, (adjusted odds ratio: 1.09, 95% CI: 1.00–1.18), compared with those with complete Part D coverage. Lack of continuous Part D coverage was associated with more ED use among Medicare FFS beneficiaries with CRC in 2007–2013. Among people with Part D coverage, prescription drug costs varied little between those with CRC and matched beneficiaries without cancer.

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Treatment of venous leg ulcers using bilayered living cellular construct

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2020-0076 ◽

2020 ◽

Vol 9 (13) ◽

pp. 907-918

Author(s):

Aseel Bin Sawad ◽

Fatema Turkistani

Keyword(s):

Healthcare System ◽

Cost Savings ◽

Standard Of Care ◽

Healthcare Resource Utilization ◽

Psychological Status ◽

Leg Ulcers ◽

Venous Leg Ulcers ◽

Time Period ◽

The Us ◽

Economic Analyses

Background: Venous leg ulcers (VLUs) present a significant economic burden on the US healthcare system and payers (US$14.9 billion). Aim: To evaluate the quality of life (QoL) of patients with VLUs; to analyze the limitations of standard of care (SOC) for VLUs; and to explain how using bilayered living cellular construct (BLCC) with SOC for treatment of VLUs can help heal more VLUs faster (than using SOC alone) as well as help improve QoL and help reduce the burden on the US healthcare system and payers. Materials & methods: This is a review study. The search was conducted in February 2020 by way of electronic databases to find relevant articles that provided information related to QoL of patients with VLUs, limitations of SOC for VLUs and economic analyses of using BLCC for treatment of VLUs. Results: VLUs impact patients’ physical, functional and psychological status and reduce QoL. A total 75% of VLU patients who used SOC alone failed to achieve healing in a timely fashion, which led to increased healthcare costs and healthcare resource utilization. Although the upfront cost is high, the greater effectiveness of BLCC offsets the added cost of the product during the time period of the studies. Therefore, BLCC helps to improve the QoL of VLU patients. As an example, for every 100 VLU patients in a healthcare plan, the use of BLCC can create cost savings of US$1,349,829.51. Conclusion: Payers’ coverage of BLCC results in reduction of the overall medical cost for treating VLU patients.

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PNS105 ASSOCIATION OF LOW-INCOME SUBSIDY/DUAL ELIGIBILITY AND DISABILITY WITH HIGH-RISK MEDICATION USE AMONG PART D MEDICARE BENEFICIARIES

Value in Health ◽

10.1016/j.jval.2020.04.1108 ◽

2020 ◽

Vol 23 ◽

pp. S303

Author(s):

C. Chinthammit ◽

S. Bhattacharjee ◽

M. Slack ◽

W. Lo-Ciganic ◽

J.P. Bentley ◽

...

Keyword(s):

High Risk ◽

Low Income ◽

Medication Use ◽

Medicare Beneficiaries ◽

Part D ◽

Dual Eligibility

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Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults

SLEEP ◽

10.1093/sleep/zsab076 ◽

2021 ◽

Author(s):

G L Dunietz ◽

R D Chervin ◽

J F Burke ◽

A S Conceicao ◽

T J Braley

Keyword(s):

Older Adults ◽

Statistical Significance ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Lower Odds ◽

Logistic Regression Models ◽

Not Otherwise Specified ◽

Dementia Risk ◽

Obstructive Sleep ◽

Study Participants

Abstract Study Objectives To examine associations between PAP therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not-otherwise-specified (DNOS) in older adults. Methods This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65+, with an OSA diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes [AD(n=1,057), DNOS(n=378), and MCI(n=443)] that were newly-identified between 2011-2013. PAP treatment was defined as presence of ≥1 durable medical equipment (HCPCS) code for PAP supplies. PAP adherence was defined as ≥2 HCPCS codes for PAP equipment, separated by≥1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses. Results In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75y. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (OR=0.78, 95% CI:0.69-0.89; and OR=0.69, 95% CI:0.55-0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR=0.82, 95% CI:0.66-1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR=0.65, 95% CI:0.56-0.76). Conclusions PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce risk of subsequent dementia.

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