Justin M Barnes1, Kimberly J Johnson2,3, Eric Adjei Boakye4,5, Rosh K V Sethi6, Mark A Varvares6, Nosayaba Osazuwa-Peters7,8. 1. Saint Louis University School of Medicine, St. Louis, Missouri. 2. Brown School, Washington University in St. Louis, St. Louis, Missouri. 3. Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri. 4. Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois. 5. Simmons Cancer Institute at Southern Illinois University, Southern Illinois University School of Medicine, Springfield, Illinois. 6. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. 7. Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri. 8. Saint Louis University Cancer Center, St. Louis, Missouri.
Abstract
BACKGROUND: Cost-related medication underuse (CRMU), a measure of access to care and financial burden, is prevalent among cancer survivors. The authors quantified the impact of the Patient Protection and Affordable Care Act (ACA) on CRMU in nonelderly cancer survivors. METHODS: Using National Health Interview Survey data (2011-2017) for cancer survivors aged 18 to 74 years, the authors estimated changes in CRMU (defined as taking medication less than prescribed due to costs) before (2011-2013) to after (2015-2017) implementation of the ACA. Difference-in-differences (DID) analyses estimated changes in CRMU after implementation of the ACA in low-income versus high-income cancer survivors, and nonelderly versus elderly cancer survivors. RESULTS: A total of 6176 cancer survivors aged 18 to 64 years and 4100 cancer survivors aged 65 to 74 years were identified. In DID analyses, there was an 8.33-percentage point (PP) (95% confidence interval, 3.06-13.6 PP; P = .002) decrease in CRMU for cancer survivors aged 18 to 64 years with income <250% of the federal poverty level (FPL) compared with those with income >400% of the FPL. There was a reduction for cancer survivors aged 55 to 64 years compared with those aged 65 to 74 years with income <400% of the FPL (-9.35 PP; 95% confidence interval, -15.6 to -3.14 PP [P = .003]). CONCLUSIONS: There was an ACA-associated reduction in CRMU noted among low-income, nonelderly cancer survivors. The ACA may improve health care access and affordability in this vulnerable population.
BACKGROUND: Cost-related medication underuse (CRMU), a measure of access to care and financial burden, is prevalent among cancer survivors. The authors quantified the impact of the Patient Protection and Affordable Care Act (ACA) on CRMU in nonelderly cancer survivors. METHODS: Using National Health Interview Survey data (2011-2017) for cancer survivors aged 18 to 74 years, the authors estimated changes in CRMU (defined as taking medication less than prescribed due to costs) before (2011-2013) to after (2015-2017) implementation of the ACA. Difference-in-differences (DID) analyses estimated changes in CRMU after implementation of the ACA in low-income versus high-income cancer survivors, and nonelderly versus elderly cancer survivors. RESULTS: A total of 6176 cancer survivors aged 18 to 64 years and 4100 cancer survivors aged 65 to 74 years were identified. In DID analyses, there was an 8.33-percentage point (PP) (95% confidence interval, 3.06-13.6 PP; P = .002) decrease in CRMU for cancer survivors aged 18 to 64 years with income <250% of the federal poverty level (FPL) compared with those with income >400% of the FPL. There was a reduction for cancer survivors aged 55 to 64 years compared with those aged 65 to 74 years with income <400% of the FPL (-9.35 PP; 95% confidence interval, -15.6 to -3.14 PP [P = .003]). CONCLUSIONS: There was an ACA-associated reduction in CRMU noted among low-income, nonelderly cancer survivors. The ACA may improve health care access and affordability in this vulnerable population.
Keywords:
National Health Interview Survey (NHIS); Patient Protection and Affordable Care Act (ACA); access to care; cancer survivors; cost-related medication underuse; difference-in-differences; financial toxicity
Authors: Justin M Barnes; Evan M Graboyes; Eric Adjei Boakye; Erin E Kent; Jeffrey F Scherrer; Eliza M Park; Donald L Rosenstein; Yvonne M Mowery; Junzo P Chino; David M Brizel; Nosayaba Osazuwa-Peters Journal: J Cancer Surviv Date: 2022-04-04 Impact factor: 4.442
Authors: Justin M Barnes; Kimberly J Johnson; Eric Adjei Boakye; Lidia Schapira; Tomi Akinyemiju; Eliza M Park; Evan M Graboyes; Nosayaba Osazuwa-Peters Journal: J Natl Cancer Inst Date: 2021-07-14 Impact factor: 11.816