Table 3.

Odds of Receiving Combination Chemotherapy That Included Drugs Affected by MMA: Analysis of 5,831 Total Regimens Initiated From 2003 to 2006

Variable	Full Model				Age 65 Years or Older Only				Cancer Subgroups
									CRC				SCLC				NSCLC
	No.	OR	95% CI	P	No.	OR	95% CI	P	No.	OR	95% CI	P	No.	OR	95% CI	P	No.	OR	95% CI	P
Total patients	3,613				1,802				1,574				409				1,630
Total regimens	5,831				2,727				2,517				674				2,640
MMA timing
Pre-MMA (ref.)		1.00				1.00				1.00				1.00				1.00
Post-MMA		0.73	0.59 to 0.89	.002		0.87	0.64 to 1.18	.378		0.65	0.46 to 0.92	.02		0.63	0.34 to 1.16	.14		1.60	1.09 to 2.35	.02
Health plan
FFS (ref.)		1.00				1.00				1.00				1.00				1.00
IHN		1.23	0.98 to 1.54	.078		1.05	0.78 to 1.40	.762		1.53	1.03 to 2.29	.04		0.63	0.31 to 1.27	.20		1.15	0.83 to 1.58	.41
Regimen order
First (ref.)		1.00				1.00				1.00				1.00				1.00
Follow-up		0.28	0.24 to 0.33	< .001		0.33	0.26 to 0.41	< .001		0.74	0.58 to 0.95	.02		0.02	0.01 to 0.06	< .001		0.17	0.13 to 0.22	< .001
Age at diagnosis (years)
< 65 (ref.)		1.00				—		—		1.00				1.00				1.00
65-74		0.69	0.57 to 0.83	< .001		—		—		0.77	0.57 to 1.05	.10		0.90	0.49 to 1.67	.74		0.60	0.44 to 0.80	< .001
75+		0.46	0.37 to 0.56	< .001		—		—		0.39	0.28 to 0.55	< .001		0.76	0.36 to 1.62	.48		0.42	0.30 to 0.58	< .001
Race/ethnicity
White (ref.)		1.00				1.00				1.00		1.00						1.00
Hispanic		0.74	0.53 to 1.04	.079		0.66	0.41 to 1.05	.083		0.69	0.45 to 1.05	.08		0.76	0.27 to 2.12	.60		0.70	0.38 to 1.29	.25
Non-Hispanic black		1.04	0.82 to 1.31	.77		0.90	0.64 to 1.26	.528		0.89	0.63 to 1.25	.49		0.63	0.29 to 1.38	.25		1.55	0.99 to 2.42	.06
Other		0.84	0.65 to 1.10	.205		0.99	0.66 to 1.48	.954		0.87	0.56 to 1.34	.52		0.76	0.39 to 1.49	.43		1.11	0.71 to 1.72	.65
Sex
Male (ref.)		1.00				1.00				1.00				1.00				1.00
Female		0.92	0.78 to 1.08	.313		0.88	0.70 to 1.10	.256		0.88	0.67 to 1.16	.38		0.71	0.44 to 1.14	.16		1.09	0.83 to 1.43	.55
Cancer type
CRC (ref.)		1.00				1.00				—		—		—		—		—		—
NSCLC		0.81	0.67 to 0.98	.034		0.83	0.64 to 1.08	.168		—		—		—		—		—		—
SCLC		0.84	0.65 to 1.09	.189		0.99	0.69 to 1.43	.968		—		—		—		—		—		—
Stage at diagnosis
I-III (ref.)		1.00				1.00				1.00				1.00				1.00
IV		0.81	0.69 to 0.95	.012		0.88	0.71 to 1.09	.236		1.11	0.85 to 1.46	.45		0.64	0.39 to 1.07	.09		0.61	0.47 to 0.79	< .001
Comorbidity (ACE-27)
None (ref.)		1.00				1.00				1.00				1.00				1.00
Mild		0.91	0.74 to 1.12	.365		0.76	0.54 to 1.08	.126		0.73	0.54 to 0.99	.04		0.82	0.42 to 1.61	.57		1.12	0.77 to 1.63	.56
Moderate		0.86	0.67 to 1.09	.208		0.71	0.48 to 1.04	.077		0.85	0.58 to 1.26	.43		0.58	0.27 to 1.23	.16		0.96	0.62 to 1.49	.86
Severe		0.92	0.70 to 1.20	.517		0.75	0.51 to 1.11	.152		0.75	0.47 to 1.22	.25		0.57	0.26 to 1.25	.16		0.96	0.63 to 1.47	.86
New drug
No (ref.)		1.00				1.00								1.00				1.00
Yes		0.71	0.54 to 0.94	.015		0.47	0.32 to 0.69	< .001		—		—		0.09	0.02 to 0.53	.01		0.03	0.01 to 0.05	< .001
Interaction: health plan-MMA timing
Overall interaction effect		1.39	0.87 to 2.21	.168		1.22	0.62 to 2.41	.559		0.73	0.36 to 1.48	.39		2.63	0.51 to 13.50	.25		3.95	1.26 to 12.40	.02
FFS: post-MMA v pre-MMA		0.73	0.59 to 0.89	.002		0.87	0.64 to 1.18	.378		0.65	0.46 to 0.92	.02		0.63	0.34 to 1.16	.14		1.60	1.09 to 2.35	.02
IHN: post-MMA v pre-MMA		1.01	0.66 to 1.56	.967		1.07	0.57 to 1.99	.836		0.47	0.25 to 0.89	.02		1.66	0.36 to 7.57	.52		6.33	2.09 to 19.11	.00

NOTE. There were 6,098 regimens initiated over the study period by Cancer Care Outcomes Research and Surveillance patients. Because of missing data on patient-level variables, 5,831 regimens remained for analysis: 3,517 first-line; 2,315 second- or later-line.

Abbreviations: ACE-27, Adult Comorbidity Evaluation 27; CRC, colorectal cancer; FFS, fee for service; IHN, integrated health network; MMA, Medicare Prescription Drug, Improvement, and Modernization Act of 2003; NSCLC, non–small-cell lung cancer; OR, odds ratio; ref., reference; SCLC, small-cell lung cancer.