Malignant mesothelioma among US Medicare beneficiaries: incidence, prevalence and therapy, 2016–2019

Abstract

ObjectivesMesothelioma is a rare, aggressive cancer caused by exposure to asbestos fibres. Mesothelioma patients who receive trimodal therapy (chemotherapy, surgical resection and radiation) survive longer than those who receive two or fewer therapy modalities. This study analyses the 2016–2019 Medicare claims data to estimate the burden of malignant mesothelioma and describe therapy patterns (when available) among continuously enrolled fee-for-service (FFS; Medicare parts A and B) beneficiaries.MethodsWe analysed claims and enrolment information from 42 529 117 FFS Medicare beneficiaries using three mesothelioma case definitions (broad, intermediate and narrow) with varying levels of diagnostic requirements. Results are presented as ranges of values for the three definitions.ResultsAmong FFS beneficiaries, 8213–19 036 beneficiaries with mesothelioma were identified depending on the case definition. The annual prevalence per 100 000 beneficiaries ranged from 8.8 in 2016 (narrow) to 31.3 in 2019 (broad) and annual incidence per 100 000 beneficiaries ranged from 4.5 in 2019 (narrow) to 12.6 in 2017 (broad). Depending on the mesothelioma case definition, 41.8%–81.5% had available therapy claim information indicating that 7.6%–11.3% received chemotherapy alone, 1.3%–1.5% received radiation alone, and 14.3%–27.0% underwent surgery only, with 4.6%–10.5% receiving all three therapy modalities.ConclusionsMesothelioma was a prevalent disease among FFS Medicare beneficiaries during 2016–2019, and a limited proportion of beneficiaries received all three therapy modalities. Medicare data build on findings from cancer registry data to enhance our understanding of the mesothelioma burden and therapy patterns.

Pneumoconiosis incidence and prevalence among US Medicare beneficiaries, 1999–2019

“…Three case definitions were developed to identify FFS beneficiaries with any type of pneumoconiosis (CWP, asbestosis, silicosis, byssinosis, cannabinosis, flax‐dressers' disease, other/unspecified pneumoconiosis) and to calculate prevalence and incidence during 1999–2019 (Figure 1). These definitions were based on patterns of diagnosis codes used by the CMS Chronic Conditions Warehouse and previous studies estimating the prevalence of chronic respiratory diseases among Medicare beneficiaries 13,22–24 . A broad pneumoconiosis definition identified beneficiaries with a FFS claim including any pneumoconiosis ICD‐9‐CM code (500–505) or ICD‐10‐CM code (J60, J61, J62.8, J63, J64, J65, or J66) (Table 1) listed in any diagnosis position.…”

“…These definitions were based on patterns of diagnosis codes used by the CMS Chronic Conditions Warehouse and previous studies estimating the prevalence of chronic respiratory diseases among Medicare beneficiaries. 13,[22][23][24] A broad pneumoconiosis definition identified beneficiaries with a FFS claim including any pneumoconiosis ICD-9-CM code (500-505) or ICD-10-CM code (J60, J61, J62.8, J63, J64, J65, or J66) (Table 1) listed in any diagnosis position. ICD-10-CM code J62.0 (pneumoconiosis due to talc dust) was excluded because mortality data research shows this code frequently represented talcosis among intravenous drug users or others.…”