Costs of care for elderly patients with myelodysplastic syndromes (MDS) enrolled in Medicare are not associated with survival, a study published online first in the journal Cancer has shown.1

Hypomethylating agents (HMAs) and other newer treatments for MDS are expensive; however, whether MDS-related health costs are associated with overall survival is unclear. In this study, researchers sought to evaluate the relationship between MDS-related costs and survival in patients enrolled in Medicare who have MDS.

The researchers identified 8580 eligible patients by searching the Surveillance, Epidemiology, and End Results–Medicare database for patients with codes for MDS from International Classification of Diseases for Oncology, 3rd edition. The patients were 66 years or older, their MDS was diagnosed between January 1, 2005 and December 31, 2011, and were followed through death or the end of the study (December 31, 2012).

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MDS-related cost estimates were based on Medicare payments minus cumulative costs in a propensity score–matched group of cancer-free Medicare beneficiaries. After adjusting for patient and disease characteristics, multivariate Cox proportional hazards models were used to develop hazard ratios (HRs) and 95% confidence intervals (CIs).

Of the eligible patients, 1267 (14.7%) received HMAs. Overall 2-year survival was 48.7%, and 2-year registry-specific MDS-related cost per patient was $40,793 to $78,156 across 16 registries. Two-year MDS-related cost was not associated with survival in the overall study population (first tertile, reference; second tertile, HR, 0.96; 95% CI, 0.89-1.04; P=.29; third tertile, HR, 0.98; 95% CI, 0.91-1.06; P=.64) or in subgroups of patients who received HMAs or did not receive these agents.

The researchers conclude that implementing cost-saving interventions may be possible without compromising patient outcomes, and therefore, additional research to identify potential areas for cost-saving are warranted.


1. Zeidan AM, Wang R, Davidoff AJ, et al. Disease-related costs of care and survival among Medicare-enrolled patients with myelodysplastic syndromes [published online ahead of print March 11, 2016]. Cancer. doi:10.1002/cncr.29945.