A study of state-specific costs of care and survival among Medicare beneficiaries with myelodysplastic syndromes (MDS) shows no correlation between the cost of care and patient outcomes. Although healthcare Medicare expenditures on elderly patients with MDS were highly variable across different states in the United States in the 2 years after diagnosis, no association was found between higher cost and survival outcomes.
“There is no clear improvement in the 2-year survival with increasing state-specific MDS-related costs of care, even after adjustment for relevant variables,” said Amer M. Zeidan, MBBS, MHS, Assistant Professor of Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT.
“This represents an opportunity to find out what accounts for differences in cost, because it could be a way to try to reduce costs without compromising patient outcomes,” said Dr Zeidan at ASH 2015.
A Costly Disease
MDS-related care is expensive and includes blood transfusions, which may exceed $31,000 annually, in addition to high-cost drugs, such as hypomethylating agents (HMAs), lenalidomide, erythropoiesis-stimulating agents, and iron chelation agents.
“In one recent analysis,” said Dr Zeidan, “the cost of MDS-related care was higher than 18 of the most prevalent cancers in the US.”
With a median patient age at diagnosis of 71 years and 80% of patients aged >65 years, MDS is a disease of the elderly. Dr Zeidan and colleagues performed a retrospective cohort analysis using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. To estimate the MDS-specific costs, the researchers used a 5% random sample of Medicare beneficiaries without cancer residing in the SEER-related geographic areas as the control group.
Patients who were aged ≥66 years at diagnosis (between January 1, 2005, and December 31, 2011) were eligible to participate. The researchers estimated MDS-specific cost per patient by state during a 2-year period—the median survival of patients with MDS. Survival was estimated as a function of the use of HMAs, demographics, health status, and cost. Of 24,347 patients diagnosed with MDS, 8564 met the eligibility criteria.
High Variation in Cost
The median 2-year MDS-related cost of care per patient was $67,717 across 12 states—ranging from $43,950 in New Mexico to as high as $83,961 in Michigan. As expected, the costs were higher among HMA users (range, $109,447-$156,156) than nonusers (range, $36,250-$55,446).
“Even among patients not treated with hypomethylating agents, the costs are very high and widely variable,” said Dr Zeidan.
The factors associated with worse 2-year survival included age >85 years, sex (males have worse survival), genetic subtype (RAEB and t-MDS), and a higher Elixhauser comorbidity score.
“All of these factors are expected,” said Dr Zeidan, “but when you look at costs, variation of cost among states doesn’t seem to translate into better survival outcomes.”
Dr Zeidan and colleagues are planning to look at hospitalization differences versus physician differences, as well as differences in transfusion practices, to determine what is responsible for the interstate variation in costs.