Impact of the Patient Protection and Affordable Care Act on cost?related medication underuse in nonelderly adult cancer survivors
Menée aux Etats-Unis par enquête sur la période 2011-2017 auprès d’un total de 10 276 patients ayant survécu à un cancer (6 176 cas âgés de 18 à 64 ans et 4 100 cas âgés de 65 à 74 ans), cette étude analyse l’effet de la loi sur la protection des patients et les soins abordables ("Obamacare") sur l’utilisation des médicaments en lien avec leur coût
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.
Cancer 2020