Abstract 716: Trends in Medicare reimbursements within the first year of cervical cancer diagnosis, 2007-2015
Authors: Karim Mohammad A. , Kodali Lakshmi S. , Shete Sanjay 
Published: April 2023

Abstract
Introduction: Although cost trends for commercially insured cervical cancer patients have been reported previously, trends in Medicare reimbursements for patients with cervical cancer have not been reported in the literature.
Methods: Using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, we estimated mean monthly Medicare reimbursements (total and stratified by service types) in the first year after cervical cancer diagnosis. Adjusted mean monthly Medicare reimbursements were estimated using two-part regression model with first part as a logistic regression and second part as a generalized linear model (GLM) with log link and gamma distribution. Age at diagnosis, race/ethnicity, marital status, census poverty indicator, urban/rural status, year of diagnosis, NCI comorbidity index (calculated using 6 months pre-diagnosis claims), cancer stage and survival status in the first year after diagnosis were used as covariates in our analyses. Trend analysis was conducted using the Joinpoint Trend Analysis software, where the summary measure Average Annual Percentage Change (AAPC) indicated increasing or decreasing trend over a fixed time period. The service-specific Medicare reimbursements were obtained for: (i) inpatient/skilled nursing facility (SNF), (ii) physician/supplier, (iii) outpatient, and, (iv) durable medical equipment (DME) related services. Cervical cancer was identified using International Classification of Diseases for Oncology, Third Edition (ICD-O-3) codes C53.0-53.9. Patients who were diagnosed with cervical cancer as a primary or first of two or more primary cancers between 2007-2015, had continuous Part A and B Medicare coverage from 6 months prior to diagnosis till December 2016 or death (whichever was earlier) but had no HMO coverage, were included in the study.
Results: Total 2731 cervical cancer patients were included in our study, of whom 19.15% (n=523) were younger than 65 years. Patients were majority white (61.81%, n=1688) and most of the patients (53.46%, n=1460) lived in metro areas with population greater than 1 million. 28.41% (n=776) of the patients died within a year of cancer diagnosis. Mean monthly total Medicare reimbursements increased from $7724 to $9371 between 2007 and 2015. Importantly, increasing trend in total Medicare reimbursements was primarily due to statistically significant increasing trend in reimbursements for outpatient services starting 2012 (AAPC=8.1, P-value &lt;0.01). Inpatient/SNF services consistently incurred the highest amounts, whereas DME services consistently incurred the lowest amounts of Medicare reimbursements.
Conclusion: Our study found recent increasing trend in outpatient services-related Medicare reimbursements for cervical cancer. Our findings highlight the need for cost related policy interventions targeting services that are major cost drivers in cervical cancer.
Citation Format: Mohammad A. Karim, Lakshmi S. Kodali, Sanjay Shete. Trends in Medicare reimbursements within the first year of cervical cancer diagnosis, 2007-2015 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 716.