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    Association of Patient Cost Sharing and Area Deprivation with Multiple Myeloma Treatment Receipt and Outcomes

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    Author
    Hong, Yoon Duk
    0000-0002-9548-5770
    Advisor
    Slejko, Julia F
    Date
    2021
    Embargo until
    08/04/2022
    Type
    dissertation
    
    Metadata
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    Abstract
    Introduction: Advances in multiple myeloma (MM) treatment have improved survival, but there are increased concerns about treatment affordability and access. This study assessed 1) how cost-sharing assistance and area deprivation affect treatment receipt, 2) changes in the patient cost responsibility and disparities in treatment over time, and 3) how the low-income subsidy (LIS), which lowers Part D cost sharing, and area deprivation affect treatment access and survival. Methods: Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients diagnosed with MM. The effect of cost-sharing assistance and area deprivation on treatment was estimated using multilevel logistic regression. We estimated the monthly incremental patient cost responsibility among MM patients compared to non-cancer controls and examined changes over time (2007-2011, 2012-2016). The effect of diagnosis period and area deprivation on treatment was estimated using multilevel logistic regression. The association between LIS, area deprivation, and mortality was estimated from a mixed-effects Cox proportional hazards model. We assessed whether treatment mediates the association between LIS and mortality. Results: Individuals receiving Medicare Parts A, B and D cost-sharing assistance had higher odds of receiving treatment compared with non-recipients (OR=1.21; 95%CI: 1.01–1.45). Living in the most deprived area (Quintile 5) was associated with lower odds of receiving treatment compared with the least deprived area (Quintile 1; OR=0.81; 95%CI: 0.65–0.99), but there was no difference in the other quintiles. The difference in the estimated monthly incremental patient cost responsibility between 2012-2015 and 2007-2011 was $58 [average marginal cost; 95%CI: $12–$105]). The difference in the likelihood of any treatment receipt between Quintile 1 and 5 decreased, but the difference in the likelihood of receiving a novel agent-based regimen increased. The mortality hazard was higher for LIS recipients relative to non-recipients in Quintiles 1, 3 and 4 (HR=1.50, 1.38, 1.28; p=0.0001), and there was no difference in the other two quintiles. This association was partially mediated by treatment receipt. Conclusions: The patient cost responsibility for MM care increased over time. The type of cost-sharing assistance and area deprivation affect treatment receipt, although not across all quintiles. LIS receipt did not confer a survival benefit.
    Description
    University of Maryland, Baltimore. Pharmaceutical Health Services Research, Ph.D. 2021
    Keyword
    Multiple Myeloma--therapy
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/18120
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    Theses and Dissertations School of Pharmacy
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