Journal of Cancer Survivorship

, Volume 5, Issue 4, pp 395–404

Cost-related medication nonadherence and cost-saving strategies used by elderly Medicare cancer survivors

  • Larissa Nekhlyudov
  • Jeanne Madden
  • Amy Johnson Graves
  • Fang Zhang
  • Stephen B. Soumerai
  • Dennis Ross-Degnan
Article

Abstract

Objectives

This study was conducted to compare cost-related medication nonadherence among elderly Medicare enrollees with and without cancer and to describe the strategies cancer survivors used to offset the costs of medications.

Methods

Using the 2005 Medicare Current Beneficiary Survey and Medicare claims, we compared self-reported cost-related medication nonadherence (CRN), spending less on basic needs to afford medicines, and cost reduction strategies among elderly beneficiaries with and without cancer. Descriptive statistics and logistic regression models were used to characterize and compare these populations.

Results

In a nationally representative sample of 9,818 non-institutionalized elderly Medicare enrollees, 1,392 (14%) were classified as cancer survivors based on Medicare claims. Cancer survivors were older, more highly educated, more likely to be male and non-Hispanic, and more likely to have multiple comorbidities, poorer health status, and employer-paid medication coverage. While 10% of cancer survivors and 11% without cancer reported CRN, about 6% and 9% (p = 0.004) of those with and without cancer, respectively, reported spending less on basic needs to offset the costs of medications. Cancer survivors who reported CRN (n = 143) had lower income (62.2% versus 48.6%, p = 0.11) and were more likely to be African-American (13.0% versus 6.4%, p = 0.033) and have non-employer-based medication insurance (p = 0.002) compared to those who did not report CRN. In adjusted analyses, CRN among the two groups was similar, but with some subgroup differences noted by gender and cancer type. Use of cost reduction strategies was mostly similar among cancer survivors and those without cancer.

Conclusion

Cost-related medication nonadherence medication is common among elderly Medicare beneficiaries, but appears to be similar among those with and without cancer.

Keywords

Cancer survivorship Cost Adherence Medicare Elderly 

References

  1. 1.
    Madden JM, Graves AJ, Zhang F, Adams AS, Briesacher BA, Ross-Degnan D, et al. Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D. JAMA. 2008;299:1922–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Piette JD, Heisler M, Wagner TH. Problems paying out-of-pocket medication costs among older adults with diabetes. Diabetes Care. 2004;27:384–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Piette JD, Wagner TH, Potter MB, Schillinger D. Health insurance status, cost-related medication underuse, and outcomes among diabetes patients in three systems of care. Med Care. 2004;42:102–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA. 2001;285:421–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Brown ML, Riley GF, Schussler N, Elzioni R. Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care. 2002;40(Supplemental IV):104–17.Google Scholar
  6. 6.
    Chang S, Long SR, Kutikova L, Bowman L, Finley D, Crown WH, et al. Estimating the cost of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol. 2004;22:3524–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Meropol NJ, Schulman KA. Cost of cancer care: issues and implications. J Clin Oncol. 2007;25:180–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Langa KM, Fendrick AM, Chernew ME, Kabeto M, Paisley KL, Hayman JA. Out-of-pocket health-care expenditures among older Americans with cancer. Value Health. 2004;7:186–94.PubMedCrossRefGoogle Scholar
  9. 9.
    The USA Today/Kaiser Family Foundation/Harvard School of Public Health. National survey of households affected by cancer. Menlo Park: The Henry J. Kaiser Family Foundation; 2006.Google Scholar
  10. 10.
    Himmelstein DU, Warren E, Thorne D, Woolhandler S. Illness and injury as contributors to bankruptcy. Health Affairs 2005;Suppl W5:63–73.Google Scholar
  11. 11.
    Institute of Medicine and National Research Council of the National Academies. From cancer patient to cancer survivor: lost in transition. Washington: The National Academies; 2006.Google Scholar
  12. 12.
    Weaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care because of cost. Assessing disparities in healthcare access among cancer survivors living in the United States. Cancer. 2010;116:3493–504.PubMedCrossRefGoogle Scholar
  13. 13.
    Pierre-Jacques M, Safran DG, Zhang F, Ross-Degnan D, Adams AS, Gurwitz J, et al. Reliability of new measures of cost related medication nonadherence. Med Care. 2008;46:444–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Bambauer KZ, Safran DG, Ross-Degnan D, Zhang F, Adams AS, Gurwitz J, et al. Depression and cost-related medication nonadherence in Medicare beneficiaries. Arch Gen Psych. 2007;64:602–8.CrossRefGoogle Scholar
  15. 15.
    Soumerai SB, Pierre-Jacques M, Ross-Degnan D, Adams AS, Gurwitz JH. Cost-related medication non-adherence among the elderly and the disabled: a national survey one year before the Medicare drug benefit. Arch Intern Med. 2006;166:1829–35.PubMedCrossRefGoogle Scholar
  16. 16.
    Tjia J, Briesacher BA, Soumerai SB, Pierre-Jacques M, Zhang F, Ross-Degnan D, et al. Medicare beneficiaries and free prescription drug samples: a national survey. J Gen Intern Med. 2008;23:709–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Yabroff KR, Warren JL, Banthin J, Schrag D, Mariotto A, Lawrence W, et al. Comparison of approaches for estimating prevalence costs of care for cancer patients: what is the impact of data source? Med Care. 2009;47(Suppl):S64–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Mohile SG, Xian Y, Dale W, Fisher SG, Rodin M, Morrow GR, et al. Association of a cancer diagnosis with vulnerability and frailty in older Medicare beneficiaries. J Natl Cancer Inst. 2009;101:1206–15.PubMedCrossRefGoogle Scholar
  19. 19.
    Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA. Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat. 2006;99:215–20.PubMedCrossRefGoogle Scholar
  20. 20.
    Owusu C, Buist DSM, Field TS, Lash TL, Thwin SS, Geiger AM, et al. Predictors of tamoxifen discontinuation among older women with estrogen receptor-breast cancer. J Clin Oncol. 2008;26:549–55.PubMedCrossRefGoogle Scholar
  21. 21.
    Partridge AH, Wang PS, Winer EP, Avorn J. Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol. 2003;21:602–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Ruddy K, Mayer E, Partridge A. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin. 2009;59:56–66.PubMedCrossRefGoogle Scholar
  23. 23.
    Chlebowski RT, Geller ML. Adherence to endocrine therapy for breast cancer. Oncology. 2006;71:1–9.PubMedGoogle Scholar
  24. 24.
    Pezzin LE, O’Niel MB, Nattinger AB. The economic consequences of breast cancer adjuvant hormonal treatments. J Gen Intern Med. 2009;24 Suppl 2:S446–50.PubMedCrossRefGoogle Scholar
  25. 25.
    Kim P. Cost of cancer care: the patient perspective. J Clin Oncol. 2007;25:228–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Krouse RS, Herrinton LJ, Grant M, Wendel CS, Green SB, Mohler MJ, et al. Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol. 2009;27:4664–70.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Larissa Nekhlyudov
    • 1
    • 2
  • Jeanne Madden
    • 1
  • Amy Johnson Graves
    • 1
  • Fang Zhang
    • 1
  • Stephen B. Soumerai
    • 1
  • Dennis Ross-Degnan
    • 1
  1. 1.Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonUSA
  2. 2.Department of MedicineHarvard Vanguard Medical AssociatesBostonUSA

Personalised recommendations