Purpose The study objective was to provide population-based estimates of supportive care medication (SCM) use among Medicare beneficiaries with cancer and determine factors related to SCM receipt. Methods This retrospective cohort study of community-based Medicare beneficiaries used the Medicare Current Beneficiary Survey (1997–2007). Dependent variables comprised use and spending on SCMs for three medication classes: opioids, antidepressants/sedative/hypnotics (ASH), and antiemetics. Independent variables of interest were supplemental insurance coverage, cancer site, and treatment. Multivariate models determined factors affecting receipt of, and spending on, SCMs. We also compared SCM use and spending among beneficiaries with and without cancer in order to understand what portion of SCM use and spending could be attributed to cancer as opposed to other comorbid conditions. Results A total of 1,836 Medicare beneficiaries with cancer and 9,898 beneficiaries without cancer were eligible for the study. Beneficiaries with cancer were more likely to receive opioids, ASH, and antiemetics compared to non-cancer beneficiaries. Adjusted annual payments for antiemetics were on average $637 higher in with cancer versus without cancer ( p < 0.01), while ASH payments were $184 lower ( p < 0.01). Opioid spending was similar among cancer and non-cancer users. Relative to colon cancer, beneficiaries with prostate cancer were least likely to receive any of the three SCM classes. Receipt of antineoplastic treatment increased the probability of use of all three classes of SCMs. Insurance coverage did not influence the use of or spending on opioids or antiemetics, but was associated with both outcomes for ASH. The use of all three SCM classes was significantly lower during years before Part D implementation of the new Medicare Part D prescription drug benefit and was higher after implementation of Part D. Conclusion This study provides population-based information on SCM use among Medicare beneficiaries with cancer. Cancer site and treatment modality were important predictors of SCM use.

Objectives: To examine whether patients with newly diagnosed cancer respond differently to supplemental coverage than the general Medicare population. Methods: A cohort of newly diagnosed cancer patients (n = 1,799) from the 1997-2007 Medicare Current Beneficiary Survey and a noncancer cohort (n = 9,726) were identified and matched by panel year. Two-year total medical care spending was estimated by using generalized linear models with gamma distribution and log link including endogeneity-corrected models. Interactions between cancer and type of insurance allowed testing for differential effects of a cancer diagnosis. Results: The cancer cohort spent an adjusted $15,605 more over 2 years than did the noncancer comparison group. Relative to those without supplemental coverage, beneficiaries with employer-sponsored insurance, other private with prescription drug coverage, and public coverage had significantly higher total spending ($3,510, $2,823, and $4,065, respectively, for main models). For beneficiaries with cancer, supplemental insurance effects were similar in magnitude yet negative, suggesting little net effect of supplemental insurance for cancer patients. The endogeneity-corrected models produced implausibly large main effects of supplemental insurance, but the Cancer x Insurance interactions were similar in both models. Conclusions: Medicare beneficiaries with cancer are less responsive to the presence and type of supplemental insurance than are beneficiaries without cancer. Proposed restrictions on the availability of supplemental insurance intended to reduce Medicare spending would be unlikely to limit expenditures by beneficiaries with cancer, but would shift the financial burden to those beneficiaries. Policymakers should consider welfare effects associated with coverage restrictions.

Background: Oral antineoplastic drugs, not generally covered by Medicare Part B, have assumed an increasingly important role in cancer treatment.Objective: We examined use and spending on infused/injected (Part B covered) and non-Part B antineoplastic agents in a Medicare beneficiary population with cancer, and the effect of supplemental insurance.Research Design: This retrospective, observational study used pooled 1997-2007 data from the Medicare Current Beneficiary Survey, linked to Medicare claims. Logistic regression models identified factors associated with antineoplastic use. Generalized linear models were used to estimate spending among antineoplastic users. Population studied: A total of 1836 Medicare beneficiaries with newly diagnosed cancer were selected based on the presence of claims-based diagnoses after a 12-month washout period.Results: Five hundred fifty-nine (31.0%) Medicare beneficiaries received antineoplastic therapy; 395 (21.3%) used Part B, 253 (14.6%) used non-Part B antineoplastics. Spending per user was $7841 (any), $10,364 (Part B), and $1535 for non-Part B antineoplastics. Supplemental insurance was associated with antineoplastic use. Primary cancer site and age were key predictors of spending among users. Spending on non-Part B antineoplastics increased during 2006-2007 relative to 2004-2005 but time trends were not significant in multivariate analysis.Conclusions: Antineoplastic therapy use by Medicare beneficiaries is sensitive to the presence but not type of supplemental insurance. Non-Part B therapy was used by a relatively large proportion of beneficiaries with cancer receiving therapy, although spending was less than for Part B therapy. Monitoring the role of supplemental insurance, and particularly the role of Medicare Part D is a critical area for ongoing research.

BACKGROUND: There is increasing concern regarding the financial burden of care on cancer patients and their families. Medicare beneficiaries often have extensive comorbidities and limited financial resources, and may face substantial cost sharing even with supplemental coverage. In the current study, the authors examined out‐of‐pocket (OOP) spending and burden relative to income for Medicare beneficiaries with cancer.

OBJECTIVE:Assess impact of Medicare Part D benefit phases on adherence with evidence-based medications after hospitalization for an acute myocardial infarction. DATA SOURCE:Random 5 percent sample of Medicare beneficiaries. STUDY DESIGN:Difference-in-difference analysis of drug adherence by AMI patients stratified by low-income subsidy (LIS) status and benefit phase. DATA COLLECTION/EXTRACTION METHODS:Subjects were identified with an AMI diagnosis in Medicare Part A files between April 2006 and December 2007 and followed until December 2008 or death (N = 8,900). Adherence was measured as percent of days covered (PDC) per month with four drug classes used in AMI treatment: angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), beta-blockers, statins, and clopidogrel. Monthly exposure to Part D benefit phases was calculated from flags on each Part D claim. PRINCIPAL FINDINGS:For non-LIS enrollees, transitioning from the initial coverage phase into the Part D coverage gap was associated with statistically significant reductions in mean PDC for all four drug classes: statins (-7.8 percent), clopidogrel (-7.0 percent), beta-blockers (-5.9 percent), and ACE inhibitor/ARBs (-5.1 percent). There were no significant changes in adherence associated with transitioning from the gap to the catastrophic coverage phase. CONCLUSIONS:As the Part D doughnut hole is gradually filled in by 2020, Medicare Part D enrollees with critical diseases such as AMI who rely heavily on brand name drugs are likely to exhibit modest increases in adherence. Those reliant on generic drugs are less likely to be affected.

ObjectiveTo examine cost responsiveness and total costs associated with a simulated "value-based" insurance design for statin therapy in a Medicare population with diabetes.MethodsFour-year panels were constructed from the 1997-2005 Medicare Current Beneficiary Survey selected by self-report or claims-based diagnoses of diabetes in year 1 and use of statins in year 2 (N = 899). We computed the number of 30-day statin prescription fills, out-of-pocket and third-party drug costs, and Medicare Part A and Part B spending. Multivariate ordinary least squares regression models predicted statin fills as a function of out-of-pocket costs, and a generalized linear model with log link predicted Medicare spending as a function of number of fills, controlling for baseline characteristics. Estimated coefficients were used to simulate changes in fills associated with co-payment caps from $25 to $1 and to compute changes in third-party payments and Medicare cost offsets associated with incremental fills. Analyses were stratified by patient cardiovascular event risk.ResultsA simulated out-of-pocket price of $25 [$1] increased plan drug spending by $340 [$794] and generated Medicare Part A/B savings of $262 [$531]; savings for high-risk patients were $558 [$1193], generating a net saving of $249 [$415].ConclusionsReducing statin co-payments for Medicare beneficiaries with diabetes resulted in modestly increased use and reduced medical spending. The value-based insurance design simulation strategy met financial feasibility criteria but only for higher-risk patients.

6028 Background: Prior research on cancer (Ca) survivors has been limited to small cohorts or claims data with limited measures. In this study we used population-based survey data to characterize multiple dimensions of the survivor experience including socioceonomic status, health status and behaviors, and healthcare spending, comparing survivors to beneficiaries w/o a Ca history. Methods: Data were pooled from the 1997-2007 Medicare Current Beneficiary Survey (MCBS) including linked claims (3 yrs prior to MCBS enrollment to concurrent). Ca survivors were identified from ICD-9-CM codes on claims or self report of a prior Ca dx, survived 2+ yrs from observed Ca dx, and had no active treatment, hospice enrollment or death in the selected survivorship yr. Beneficiary characteristics and healthcare use were based on self report augmented by claims-based measures. Bivariate and multivariate analyses were used to compare survivors’ characteristics and spending to controls. Results: The study included 3,921 survivors and 7,056 subjects w/o Ca. Among survivors, breast (21%), prostate (21%), and colorectal (16%) were most common Ca sites. Compared to controls without (w/o) Ca, survivors had higher income and assets, were more likely to have supplemental medical and prescription drug coverage (74% vs. 70%), had more comorbid conditions as measured by Charlson Comorbidity Index score >=2 (18% vs. 15%), and a smoking history (60% vs. 53%); survivors were less likely to avoid visiting doctors (22% vs. 30%), and more satisfied with the quality of medical care received (96% vs. 92%). Survivors had higher annual healthcare spending (mean $12,095 vs. $8,928) and outpatient drug spending ($2,205 vs. $1,898). All differences in healthcare use and spending remained significant after adjusting for socioeconomic status, health conditions, and behaviors. Conclusions: Elderly Ca survivorshad more supplemental insurance coverage, stronger preferences for medical care, used more preventive services, and had higher spending compared to beneficiaries w/o Ca. These patterns may reflect the effects of survivorship on need for healthcare and care seeking behaviors.

Objectives The goal of Medicare Part D medication therapy management programmes (MTMPs) is to optimize medication use by beneficiaries. The Centers for Medicare & Medicaid Services require prescription drug plans (PDPs) to consider numbers of chronic medications and conditions, and total Part D spending when targeting beneficiaries for MTMPs. However, there is no explicit evidence base establishing these criteria. The objectives were to examine the associations of Part D spending with medication use and adherence among Medicare beneficiaries with chronic obstructive pulmonary disease (COPD).Methods This retrospective cross-sectional study used a 5% random sample of Medicare beneficiaries with COPD enrolled in stand-alone PDPs and Medicare Parts A and B in 2006-2007 (n = 72 912). Maintenance medication use and adherence for COPD were measured in three domains: discontinuation, duration of therapy and proportion of days covered.Key findings Proportions of beneficiaries using COPD maintenance medications increased with Part D spending, from 33.4% (quintile 1) to 60.5% (quintile 5), after covariant adjustment. Among maintenance medication users, the adjusted proportions of beneficiaries exhibiting better adherence also increased with spending, with the top 20% of spenders having the highest proportion of beneficiaries exhibiting good adherence. Adjusted proportions of beneficiaries discontinuing medications decreased with increased Part D spending.Conclusions The Part D MTMP spending criterion (US$4000 in 2007; US$3000 in 2010) may be an inappropriate target for identifying Medicare beneficiaries in need of adherence counselling. Findings suggest higher spenders may have learned healthy adherence behaviours, whereas lower spenders may be prone to discontinue medication and/or demonstrate poor adherence behaviours.

Background: Although maintenance medications are a cornerstone of chronic obstructive pulmonary disease (COPD) management, adherence remains suboptimal. Poor medication adherence is implicated in poor outcomes with other chronic conditions; however, little is understood regarding links between adherence and outcomes in COPD patients.Objective: This study investigates the association of COPD maintenance medication adherence with hospitalization and health care spending.Methods: Using the 2006 to 2007 Chronic Condition Warehouse administrative data, this retrospective cross-sectional study included 33,816 Medicare beneficiaries diagnosed with COPD who received at least 2 prescriptions for >= 1 COPD maintenance medications. After a 6-month baseline period (January 1, 2006 to June 30, 2006), beneficiaries were followed through to December 31, 2007 or death. Two medication adherence measures were assessed: medication continuity and proportion of days covered (PDC). PDC values ranged from 0 to 1 and were calculated as the number of days with any COPD maintenance medication divided by duration of therapy with these agents. The association of adherence with all-cause hospital events and Medicare spending were estimated using negative binomial and gamma generalized linear models, respectively, adjusting for sociodemographics, Social Security disability insurance status, low-income subsidy status, comorbidities, and proxy measures of disease severity.Results: Improved adherence using both measures was significantly associated with reduced rate of all-cause hospitalization and lower Medicare spending. Patients who continued with their medications had lower hospitalization rates (relative rate [RR] = 0.88) and lower Medicare spending (-$3764), compared with patients who discontinued medications. Similarly, patients with PDC >= 0.80 exhibited lower hospitalization rates (RR = 0.90) and decreased spending (-$2185), compared with patients with PDC <0.80.Conclusions: COPD patients with higher adherence to prescribed regimens experienced fewer hospitalizations and lower Medicare costs than those who exhibited lower adherence behaviors. Findings suggested the clinical and economic importance of medication adherence in the management of COPD patients in the Medicare population. (Am J Geriatr Pharmacother. 2012;10:201-210) (C) 2012 Elsevier HS Journals, Inc. All rights reserved.

6075 Background: Concern is increasing about the OOP burden faced by cancer patients (pts). Medicare beneficiaries have multiple comorbidities, have limited financial resources, and may face substantial cost sharing under traditional Medicare if they do not have generous supplemental coverage. We examined OOP spending and burden relative to income for Medicare beneficiaries with cancer, compared to a non-cancer comparison group. Methods: We used Medicare Current Beneficiary Survey data (1997-2007). Newly diagnosed cancer pts were selected using ICD-9CM codes on claims after a 12 mos washout period. OOP spending was assessed using self report for the index(diagnosis) and subsequent year. Pt characteristics were self reported. Generalized Linear Models estimated effects of pt characteristics on OOP spending; logistic regression identified pt characteristics associated with high burden, defined as OOP spending >20% of income. Results: The cohort included 1,869 beneficiaries with, and 10,057 beneficiaries without cancer. Relative to the non-cancer cohort, cancer pts were older, had greater comorbidities, and were more likely to lack supplemental coverage (22 vs 16%) (all at p<0.01).OOP spending was $4,727 or 11.4% of total spending for cancer pts. The unadjusted difference between cancer and non-cancer pts in OOP spending was $1,518 (p<.001); with adjustment for patient characteristics, cancer patients faced an incremental $956 (p<.01) in OOP spending. Median[mean] OOP/income was 10%[24%] for beneficiaries with, compared to 6%[14%] without cancer (p<.001). Over ¼ (28%) of beneficiaries with cancer spent 20% of their income OOP, compared to 16% of beneficiaries without cancer (p<.001). Supplemental insurance and higher income were protective against high OOP burden, whereas assets, comorbidity, and receipt of cancer-directed radiation and antineoplastic therapy were associated with higher OOP burden. Conclusions: Medicare beneficiaries with cancer face higher OOP burden than their counterparts without cancer; some of the higher burden was explained by higher comorbidity burden and lack of supplemental insurance. Financial pressures may discourage some elderly patients from pursuing treatment.

6060 Background: Oral antineoplastic agents (OAA) represent a growing sector of cancer therapy. Prior studies of older adult cancer patients (pts) examined use of infused/ injected chemotherapy (IICT) covered by Medicare Part B. We examined trends in IICT and OAA use, and the effect of supplemental coverage on AT use and spending. Methods: We used Medicare Current Beneficiary Survey data (1997-2007). Newly diagnosed cancer pts were selected using ICD-9CM codes. IICT use was identified from Part B claims; OAAs were identified from self reported prescription medication events. Supplemental coverage and pt characteristics were assessed from administrative records and self-report. Total spending summed payments from all sources during the cancer diagnosis and subsequent year. Logistic regression examined factors associated with use of any and type of AT; Generalized Linear Models estimated factors associated with spending. Results: Of 1,836 newly diagnosed cancer pts 559 (31%) received AT; 395 (21%) used IICT and 253 (15%) used OAAs. Spending per user was $7,544(AT), $9,892 (IICT), and $1,535 (OAA). Supplemental coverage was associated with increased odds of AT use compared to no supplemental coverage (see Table). Cancer site and age were key predictors of spending among users. OAA spending increased during 2006-7 relative to 2004-5. Conclusions: AT use in Medicare beneficiaries is sensitive to the presence but not type of supplemental coverage. OAAs were used by a relatively large proportion of cancer pts receiving AT, although spending was less than for IICT during this largely pre-Part D period. With the growing number of relatively new OAAs, and more in the pipeline, monitoring the role of supplemental coverage, and particularly the role of Part D on access and spending is a critical area for ongoing research. [Table: see text]

OBJECTIVESTo (1) measure utilization of and adherence to heart failure medications and (2) assess whether better adherence is associated with lower Medicare spending.STUDY DESIGNPooled cross-sectional design using six 3-year cohorts of Medicare beneficiaries with congestive heart failure (CHF) from 1997 through 2005 (N = 2204).METHODSAdherence to treatment was measured using average daily pill counts. Bivariate and multivariate methods were used to examine the relationship between medication adherence and Medicare spending. Multivariate analyses included extensive variables to control for confounding, including healthy adherer bias.RESULTSApproximately 58% of the cohort were taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), 72% a diuretic, 37% a beta-blocker, and 34% a cardiac glycoside. Unadjusted results showed that a 10% increase in average daily pill count for ACE inhibitors or ARBs, beta-blockers, diuretics, or cardiac glycosides was associated with reductions in Medicare spending of $508 (not significant [NS]), $608 (NS), $250 (NS), and $1244 (P <.05), respectively. Estimated adjusted marginal effects of a 10% increase in daily pill counts for beta-blockers and cardiac glycosides were reductions in cumulative 3-year Medicare spending of $510 to $561 and $750 to $923, respectively (P <.05).CONCLUSIONSHigher levels of medication adherence among Medicare beneficiaries with CHF were associated with lower cumulative Medicare spending over 3 years, with savings generally exceeding the costs of the drugs in question.

We examined persistence in seven common preventive health practices for a nationally representative sample of Medicare beneficiaries over 4-year observation periods. Six panels from the 1997-2005 Medicare Current Beneficiary Survey (MCBS) were used resulting in 13,913 unique individuals with ages ranging from below 65 (disabled) to over 80 years old. Persistence in behavior was defined as the proportion of the observation period beneficiaries participated in each activity. We estimated behavioral persistence as a function of baseline demographic, socioeconomic, and health characteristics using multivariate regression analysis. Beneficiaries were most persistent in smoking abstinence (81% reported not smoking) and least persistent with routine exercise (47% reporting none). From multivariate regression results, there was greater persistence among beneficiaries who were married when compared to those living alone (p 300% FPL compared to <100% FPL all p < 0.01). Increasing age (greater than 80 compared to 65 - 69) was associated with increased compliance in influenza vaccination and smoking cessation (p < 0.01) while negatively associated with weekly exercise and cancer screenings (p < 0.01). Medicare beneficiaries are inconsistently persistent with common preventive health practices.

OBJECTIVE To measure 3-year medication possession ratios (MPRs) for renin-angiotensin-aldosterone system (RAAS) inhibitors and statins for Medicare beneficiaries with diabetes, and to assess whether better adherence is associated with lower spending on traditional Medicare services controlling for biases common to previous adherence studies. DATA SOURCE Medicare Current Beneficiary Survey data from 1997 to 2005. STUDY DESIGN Longitudinal study of RAAS-inhibitor and statin utilization over 3 years. DATA COLLECTION The relationship between MPR and Medicare costs was tested in multivariate models with extensive behavioral variables to control for indication bias and healthy adherer bias. PRINCIPAL FINDINGS Over 3 years, median MPR values were 0.88 for RAAS-I users and 0.77 for statin users. Higher adherence was strongly associated with lower Medicare spending in the multivariate analysis. A 10 percentage point increase in statin MPR was associated with U.S.$832 lower Medicare spending (SE=219; p<.01). A 10 percentage point increase in MPR for RAAS-Is was associated with U.S.$285 lower Medicare costs (SE=114; p<.05). CONCLUSIONS Higher adherence with RAAS-Is and statins by Medicare beneficiaries with diabetes results in lower cumulative Medicare spending over 3 years. At the margin, Medicare savings exceed the cost of the drugs.

Background: Influenza accounts for a large proportion of hospitalizations and deaths among older adults, resulting in substantial health care expenses. Influenza vaccinations are effective in reducing respiratory infections in younger populations, but it is less certain whether they reduce costs associated with respiratory infections among older adults.Objective: The purpose of this study was to determine whether influenza vaccination of older adult Medicare beneficiaries reduced costs associated with acute and chronic respiratory conditions during 3 recent influenza seasons.Methods: This study analyzed the relationship between influenza vaccination and costs for respiratory conditions among Medicare beneficiaries >= 55 years of age in influenza seasons (October May) between 2002 and 2005 using data from the Medicare Current Beneficiary Survey. Two-part multiple regressions of vaccination status were estimated on the probability and cost of treating respiratory conditions in each influenza season controlling for influenza risk factors and other covariates. Various sensitivity tests were conducted by type of service, subgroup analysis for specific population risk segments, propensity score-matched comparisons, and difference equations.Results: The study sample included 13,402 Medicare beneficiaries for the 3 influenza seasons examined. Vaccination rates varied between 67.3% and 74.9% over the 3 influenza seasons. In unadjusted comparisons, no significant difference in the cost of treating respiratory conditions was found between vaccinated and unvaccinated beneficiaries in 2002/2003 (-$104), but vaccinated beneficiaries had significantly higher mean cost differentials in the more recent influenza seasons ($258 in 2003/2004, P = 0.012; $254 in 2004/2005, P = 0.003). Based on 2-part multiple regressions of vaccine status over the 3 seasons combined, costs of respiratory conditions were $142 dollars higher on average for vaccinated beneficiaries (P = 0.014). The base regression models showed no significant cost savings from vaccination in any year. Results of 2 of the 54 sensitivity tests that were conducted indicated significant savings from vaccination (inpatient costs for 2002/2003 and difference in total costs for persons unvaccinated in 2002/2003 but vaccinated in 2003/2004).Conclusion: In this study of older adults, no significant cost savings were found with influenza vaccines in the 3 influenza seasons examined (2002-2005) when the outcome was measured in terms of differential spending for acute and chronic respiratory conditions. (Am J Geriatr Pharmacother. 2010;8:201-214) (C) 2010 Excerpta Medica Inc.

The law that created Medicare's prescription drug benefit, Medicare Part D, also established extra help for low-income seniors in the form of a subsidy. This study, the first in-depth analysis of Part D enrollment among Medicare beneficiaries without prior drug coverage, finds that 63 percent of all eligible seniors and 69 percent of low-income beneficiaries were enrolled in Part D in 2006. However, only 29 percent of low-income beneficiaries were enrolled in the subsidy program, leaving millions without coverage. Many reported that premiums were too costly, enrollment too difficult, and information too hard to obtain for enrollment. Additionally, provisions of the recently enacted Patient Protection and Affordable Care Act may have the perverse impact of reducing enrollment in Part D for certain beneficiaries. Our findings emphasize the need to expand eligibility and improve policies to foster enrollment.

OBJECTIVES:To determine whether use of symptom relief drugs (e.g., antidepressants, anxiolytics, opioid analgesics, sleep aids) rises and use of two commonly prescribed classes of chronic medications (statins and osteoporosis drugs) falls with greater probability of death for older Medicare beneficiaries.DESIGN:Pooled cross-sectional study.SETTING:Noninstitutionalized older Medicare population in 2000 to 2005.PARTICIPANTS:Community-dwelling Medicare beneficiaries aged 65 and older (N=20,233).MEASUREMENTS:Use of medications measured according to dichotomous flags; intensity of use by annual medication fills. Annual probability of death modeled using logistic regression and stratified into seven groups with predicted probabilities of death that range from less than 5% to greater than 50%. Prevalence of use and intensity (mean prescription fills per month) were computed for each class of medication.RESULTS:For symptom relief medications, there is relatively constant use with increasing probability of death, along with greater intensity of use. For the two chronic medications, there was a monotonic decrease in use but at a relatively constant intensity. Decline in statin use ranged from 34.4% in the lowest mortality stratum to 17.6% for those in the highest (P<.001). Use of osteoporosis drugs fell from 10.4% to 6.6% over the same range (P<.001).CONCLUSION:Greater intensity of use of symptom relief medications with increasing probability of death is consistent with hypothesized use. The different profile for chronic medications suggests that the time to benefit is being considered regarding therapy initiation, which results in lower use.

Background: Chronic obstructive pulmonary disease (COPD) is associated with high levels of hospitalization and health care expenditures among the aged. Adherence to appropriate maintenance drug regimens has been reported to reduce hospitalization and health care spending in clinical trials. However, little research has been conducted to compare use versus nonuse of these medications in terms of health-related outcomes in routine practice.Objective: The purpose of this study was to compare differences between users and nonusers of maintenance medications in terms of selected outcomes for a nationally representative sample of Medicare beneficiaries with COPD.Methods: The study sample was selected from Medicare Current Beneficiary Surveys conducted between 1997 and 2005. Beneficiaries with COPD who used >= 1 maintenance medication annually were compared with nonusers on 3 claims-based outcomes: any hospitalization, any rehospitalization within 31 days, and total annual Medicare expenditures.Results: The study sample consisted of 6322 Medicare beneficiaries who contributed a total of 9161 person-year observations for analysis. Over the 9-year study period, 39.9% (3659/9161) of the person-year observations were recorded for maintenance medication users, and 60.1% (5502/9161) were recorded for nonusers. Most of the observations for medication users involved beneficiaries who were female (50.1% [1833/3659]), non-Hispanic white (85.4% [3124/3659]), and >= 65 years of age (88.2% [3228/3659]); most of the observations for nonusers involved beneficiaries who were male (51.9% [2855/5502]), non-Hispanic white (82.7% [4550/5502]), and >= 65 years of age (88.1% [4848/5502]). Annually, 40% of the sample filled prescriptions for COPD maintenance medications. In multivariate models, maintenance drug users were less likely than nonusers to be hospitalized (odds ratio [OR] = 0.70; 95% CI, 0.61 to 0.79) or rehospitalized (OR = 0.74; 95% CI, 0.63 to 0.87), and had significantly lower annual Medicare expenditures (-$3916; 95% CI, -$4977 to -$2854).Conclusions: In this comparison of users and nonusers of maintenance medication for COPD, use of maintenance therapy was associated with significantly lower risks of hospitalization and rehospitalization and reduced Medicare expenditures. (Am J Geriatr Pharmacother. 2010;8:441-453) (C) 2010 Elsevier HS Journals, Inc.