Medicare Patients with Advanced Systemic Mastocytosis Have a Higher Financial Burden and Use More Healthcare Resources

Conference Correspondent

Systemic mastocytosis (SM) is primarily driven by mutations in KIT D816V. Advanced SM (AdvSM) may be categorized into 3 subtypes, including aggressive SM, SM associated with a hematologic component, and mast-cell leukemia. AdvSM typically develops in patients aged >60 years but the burden of the cost of therapy has not been extensively investigated, especially in the Medicare population. The current study aims to evaluate differences in medical costs and clinical outcomes in patients with or without AdvSM. A total of 339 participants aged 68.2 13.2 years with AdvSM and 339 participants aged 68.5 13.9 years without AdvSM were enrolled in the study. Of the entire cohort, 59% were female and 91% were white. Compared with non-AdvSM patients, those with AdvSM visited a specialist or the emergency department at a greater rate, had higher rates of asthma and malignancies but lower rates of hypertension and diabetes.

The 12 months following baseline, all-cause Medicare expenses were higher in the AdvSM group than in the non-AdvSM group (mean, $123,412 vs $47,988, respectively; P = .0001). Furthermore, patients with AdvSM also had higher pharmacy costs (41% of total costs vs 19% in the non-AdvSM group), in-patient hospitalization (58% of total cost vs 42% in the non-AdvSM group), and a longer-duration hospital stay (13.1 vs 5.22 days; P .0001). The AdvSM group was also twice as likely to require emergency care and visit oncology and immunology specialists.

This analysis demonstrates that Medicare patients diagnosed with AdvSM utilize more healthcare resources and experience greater financial burden for medications, physician visits, and longer hospital stays compared with Medicare patients without AdvSM. Among the patients with AdvSM, 25% were aged <65 years and qualified for Medicare due to preexisting disability, which is a higher proportion than in the general Medicare population (14%). The investigators conclude that patients with AdvSM are likely to be approved for Medicare based on preexisting disability, whereas the general Medicare population is more likely to qualify based on age, and emphasize the need for more research on Medicare benefits and management of AdvSM.

Sullivan EM, Cohen J, Norregaar C, et al. Healthcare resource utilization and costs of advanced systemic mastocytosis among Medicare fee for service beneficiaries. 2021 American Society of Hematology Annual Meeting and Exposition; December 11-14, 2021. Abstract 4048.

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