Timing of Medicare Loss Linked to Kidney Transplant Outcomes
MONDAY, March 11, 2019 -- Kidney transplant recipients receiving Medicare who lose coverage before or after the current three-year policy time point have an increased risk for allograft loss, according to a study published online March 5 in the American Journal of Transplantation.
Allyson Hart, M.D., from the Hennepin Healthcare Research Institute in Minneapolis, and colleagues analyzed 78,861 Medicare-covered, kidney-alone recipients aged <65 years. The authors examined the impact of the timing of Medicare loss posttransplant (less than three years, at three years, or more than three years) on immunosuppressive medication use and kidney transplant outcomes.
The researchers found that for all immunosuppressive medication types, the medication possession ratio (MPR) was lower for recipients with early or late Medicare loss versus no coverage loss. Early Medicare loss correlated with 53 to 86 percent lower MPR for calcineurin inhibitors. There was no correlation for on-time Medicare loss with a lower MPR. The hazard of allograft loss was 990 to 1,630 percent higher after early Medicare loss and 140 to 740 percent higher after late Medicare loss when recipients were matched by age, posttransplant timing of Medicare loss, and donor risk; no difference in risk was seen for on-time Medicare loss.
"This finding has substantial policy implications, suggesting that closer examination of the risks of Medicare loss, as well as medical coverage safety nets and access to immunosuppressive medications, beyond simply extending Medicare eligibility for transplant recipients, is critical," the authors write.
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Posted: March 2019