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Medicare HMO costs may prevent cancer patient clinical trial participation
Date:9/23/2008

PITTSBURGH, Sept. 23 Newly diagnosed cancer patients who are enrolled in Medicare's Health Maintenance Organization (HMO) plans may be unlikely to participate in clinical trials because of prohibitive costs, according to a study by the University of Pittsburgh Cancer Institute (UPCI). Under these HMO plans, covering people age 65 and older, patients are required to pay both a deductible and 20 percent of the treatment cost. As a result, access to state-of-the-art care is limited for some of society's most vulnerable members. This research will be announced during the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.

According to Chyongchiou Lin, Ph.D., lead author of the study and associate professor of health economics in UPCI's Department of Radiation Oncology, two-thirds of cancer patients are age 65 or older, with 60 percent of new cancersand 70 percent of cancer-related deathsoccurring in this age group. At the same time, less than one-third of clinical trial enrollees fall into this age group, and patients often cite cost and insurance coverage as barriers to their participation. Because the Medicare HMO payment policy requires significant personal expense, Dr. Lin and her team believe the disparity in clinical trials representation and the payment policy are likely to be related.

"Clinical trials are the cornerstone in finding better, more effective cancer treatments," said Dr. Lin. "The National Cancer Institute (NCI) has made clinical trial participation a national priority, yet current Medicare reimbursement policies present a participation barrier for a large number of patients, cutting them off from cutting-edge treatments. The current policy should be re-examined to be consistent with NCI initiatives."

The study shows the overall proportion of newly diagnosed cancer patients who had consultations and were insured by Medicare HMOs increased from 21 percent in 2003 to 27 percent in
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Contact: Courtney McCrimmon
McCrimmonCP@upmc.edu
412-647-3555
University of Pittsburgh Schools of the Health Sciences
Source:Eurekalert

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