ORLANDO, FLDespite varied US state Medicare expenditures for elderly patients with myelodysplastic syndrome (MDS), no differences were observed for overall survival, according to study results presented at the 57th American Society of Hematology (ASH) Annual Meeting.1

“Blood products, supportive care, and hypomethylating agents are frequently used to improve outcomes of patients with MDS, and they may incur substantial costs,” said Amer M. Zeidan, MBBS, MHS, of the Yale University School of Medicine in New Haven, CT.

To determine whether disease-related costs of care are associated with overall survival in patients with MDS, the investigators “evaluated the relationship between MDS-specific costs and survival among Medicare-enrolled beneficiaries with MDS in the United States.”

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Patients 66 years of age and older diagnosed with MDS between January 1, 2005, and December 31, 2011, were identified in the linked Surveillance, Epidemiology, and End Results (SEER) – Medicare database (24,347 patients). Those with continuous enrollment in Medicare Parts A and B from 1 year prior to diagnosis through death or end of study follow-up were included in the study (8,564 patients). Of the study group, 86.7% were white, 53.0% were male, 52.5% were 80 years or older at diagnosis, and 15.7% received hypomethylating agents.

By the end of follow-up, 6,011 patients (70.2%) had died; median follow-up was 1.57 years for all patients and 3.17 years for living patients. The 2-year overall survival rate was 48.7% and median overall survival, 1.84 years.

The mean 2-year MDS-related cost of care per patient was $67,717 (California), ranging between $43,950 (New Mexico) and $83,961 (Michigan) across 12 states. Costs were higher among those who used hypomethylating agents; the range was $109,447 to $156,156, compared with a range of $36,250 to $55,446 for nonusers (7,222 patients).

“In a multivariate model of the entire study cohort, factors associated with improved survival included female gender, non-white race, younger age at diagnosis, refractory anemia and refractory anemia with ring sideroblasts histologic subtypes, lower prediagnosis health costs, and lower Elixhauser comorbidity and lower disability status scores,” Dr. Zeidan reported.

The 2-year state-level MDS-related cost was not associated with survival. Using the lowest tertile as a reference, the hazard ratio (HR) for the middle tertile was 1.02 (95% CI: 0.93–1.12; P = .74), and for the highest tertile, HR 0.99 (95% CI: 0.92–1.06, P = .73).

Among nonusers of hypomethylating agents, no association between 2-year MDS-related costs and overall survival was observed. Separate analyses using 3-year MDS-related costs also showed no association between costs and survival in the overall study cohort or in the hypomethylating agents nonuser subcohort.

“The lack of association between costs and outcome warrants additional research, as it may help identify potential areas for cost saving interventions without compromising outcomes,” Dr. Zeiden concluded.


1. Zeidan AM, Wang R, Davidoff AJ, et al. Lack of association between costs of care and overall survival (OS) among medicare beneficiaries with myelodysplastic syndromes (MDS) in the United States (US). Oral presentation at: 57th American Society of Hematology (ASH) Annual Meeting & Exposition; December 7, 2015; Orlando, FL.