Multilevel factors associated with disparities in the use of targeted cancer therapies in Medicare

与医疗保险中靶向癌症治疗使用差异相关的多层次因素

• 批准号: 10830588
• 负责人: Anita Y. Kinney
• 金额: $ 12.5万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-09 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10830588
• 关键词: Accounting; Address; Advanced Malignant Neoplasm; Age; Antineoplastic Agents; Black Populations; Cancer health equity; Clinical; Data; Disparity; Disseminated Malignant Neoplasm; Enrollment; Equity; Ethnic Population; Future; Genomics; Guide prevention; Health Insurance; Health Policy; Healthcare; Improve Access; Insurance; Insurance Benefits; Low income; Malignant Neoplasms; Medicare; Medicine; Oral; Oral Administration; Parents; Pathogenicity; Patients; Pharmaceutical Preparations; Policies; Risk; Role; Services; Testing; Variant; access disparities; beneficiary; cancer genomics; cancer therapy; design; effective therapy; ethnic disparity; experience; genetic testing; improved; interest; mortality; next generation; next generation sequencing; payment; primary outcome; racial disparity; racial population; response; socioeconomic disparity; targeted cancer therapy; targeted treatment; tumor

ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 23-044. Identification of patients with pathogenic variants is crucial to enable the use of treatment and guide prevention. Yet, there are important racial disparities in genomic cancer medicine: for example, Black persons experience significant disparities in access to germline cancer genomic services and bear the largest cancer mortality burden of any racial/ethnic group. Preliminary evidence suggests that there may also be disparities in the use of genomically-targeted therapies. While the parent R01 focuses on well-known disparities in germline cancer genomic risk testing, considerably less is known about whether there are disparities in the use of genomically-targeted cancer therapies. We will assess these disparities and the potentially important role of health policy factors as they relate to disparities among cancer cases ages in Medicare. In March 2018, to improve Medicare beneficiaries’ access to targeted genomic cancer therapies, CMS issued a national coverage determination (NCD) paying for Next Generation Sequencing (NGS) based tumor genomic tests for patients with advanced or metastatic cancer and no previous NGS testing. Implementing the new payment policy by Medicare is intended to increase the use of genomically-targeted cancer treatments. However, little is known about how the implementation of the national policy for NGS testing has influenced disparities in the use of genomically-targeted therapies. To inform future healthcare coverage policies around genomic cancer medicine, it is important to assess whether the coverage policy equitably addresses access to effective treatment, given the disparities observed in both genetic testing and targeted treatments. This study will address this gap. Using the most recent five years of SEER-Medicare Part D data, we will first document whether the implementation of NCD for NGS testing has increased the use of genomically-targeted therapies. Then, we will examine whether there are racial and socio-economic disparities in the use of these therapies, accounting for the 2018 NCD for NGS testing. The use of selected genomically-targeted oral anticancer drugs before vs. after the NCD will be the primary outcome of interest. Policy-level variables will include health insurance factors such as patients’ Medicare Advantage enrollment, low-income subsidy status, and patients with coordination of benefits from third parties. The specific aims of the proposed study are to 1) compare the use of orally administered genomically-targeted cancer agents among Medicare beneficiaries before and after the implementation of the 2018 NCD policy for NGS testing; 2) examine racial-ethnic and socioeconomic disparities in the use of oral genomically-targeted cancer drugs associated with insurance benefit designs. Findings from this study can be used to inform policy decisions for advancing cancer health equity and improving access to genomically-targeted cancer therapies. This approach could be applied to other drugs and genomic medications, as well as value-based healthcare initiatives.

抽象的 该申请是为了响应特殊利益通知（NOSI）而提交 23-044。鉴定病原变异的患者对于能够使用治疗和指导至关重要 预防。但是，基因组癌症医学中存在重要的种族差异：例如，黑人 在获得种系癌症基因组服务方面经历了重大分布并拥有最大的癌症 任何种族/族裔的死亡率伯恩。初步证据表明 使用基因组靶向疗法。父母R01专注于种系的知名差异 癌症基因组风险测试，考虑是否存在差异 基因组靶向的癌症疗法。我们将评估这些差异和潜在的重要作用 健康政策因素与Medicare癌症病例之间的差异有关。 2018年3月， 改善医疗保险受益人对有针对性的基因组癌症疗法的访问，CMS发布了国家 基于下一代测序（NGS）的肿瘤基因组测试的覆盖范围确定（NCD） 患有晚期或转移性癌症的患者，没有先前的NGS检测。实施新付款 Medicare的政策旨在增加基因组靶向癌症治疗的使用。但是，几乎没有 知道国家NGS测试政策的实施如何影响分布 使用基因组靶向疗法。告知未来的医疗保健覆盖范围围绕基因组癌症的政策 医学，重要的是要评估覆盖范围政策是否平均解决有效的访问 鉴于在基因检测和靶向治疗中观察到的分布。这项研究会 解决此差距。使用Seer-Medicare D部分数据的最新五年，我们将首先记录 NCD在NGS测试中的实施是否增加了基因组靶向疗法的使用。 然后，我们将研究这些疗法的使用中是否存在种族和社会经济差异， 为NGS测试的2018 NCD考虑。使用选定的基因组靶向口服抗癌药物 在NCD之后，在NCD之后将是感兴趣的主要结果。政策级变量将包括健康 保险因素，例如患者的医疗保险优势注册，低收入补贴状态和患者 通过从第三方获得福利的协调。拟议研究的具体目的是1）比较 在Medicare受益人中使用口服的基因靶向癌症药物之前和之后 NGS测试的2018 NCD政策的实施； 2）审查种族和社会经济 使用与保险福利设计相关的口服基因组靶向癌症药物的差异。 这项研究的结果可用于为促进癌症健康公平和 改善获得基因组靶向的癌症疗法的机会。这种方法可以应用于其他药物， 基因组药物以及基于价值的医疗保健计划。