BACKGROUND Cost-related medication underuse (CRMU), a measure of access to care and financial burden, is prevalent among cancer survivors. The authors quantified the impact of the Patient Protection and Affordable Care Act (ACA) on CRMU in nonelderly cancer survivors. METHODS Using National Health Interview Survey data (2011-2017) for cancer survivors aged 18 to 74 years, the authors estimated changes in CRMU (defined as taking medication less than prescribed due to costs) before (2011-2013) to after (2015-2017) implementation of the ACA. Difference-in-differences (DID) analyses estimated changes in CRMU after implementation of the ACA in low-income versus high-income cancer survivors, and nonelderly versus elderly cancer survivors. RESULTS A total of 6176 cancer survivors aged 18 to 64 years and 4100 cancer survivors aged 65 to 74 years were identified. In DID analyses, there was an 8.33-percentage point (PP) (95% confidence interval, 3.06-13.6 PP; P = .002) decrease in CRMU for cancer survivors aged 18 to 64 years with income <250% of the federal poverty level (FPL) compared with those with income >400% of the FPL. There was a reduction for cancer survivors aged 55 to 64 years compared with those aged 65 to 74 years with income <400% of the FPL (-9.35 PP; 95% confidence interval, -15.6 to -3.14 PP [P = .003]). CONCLUSIONS There was an ACA-associated reduction in CRMU noted among low-income, nonelderly cancer survivors. The ACA may improve health care access and affordability in this vulnerable population.

中文翻译：

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《患者保护和负担得起的护理法》对成年成年癌症幸存者未充分使用成本相关药物的影响。

背景技术与成本有关的未充分使用药物（CRMU）是衡量癌症患者幸存程度的一种手段，它是获得医疗和经济负担的一种手段。作者量化了《患者保护和负担得起的医疗法案》（ACA）对非老年癌症幸存者CRMU的影响。方法使用针对18至74岁癌症幸存者的国家健康访问调查数据（2011-2017），作者估计了（2011-2013）之前（2015-2013）以后CRMU（定义为因费用而服用的药物少于处方） 2017）实施ACA。差异差异（DID）分析了在低收入与高收入癌症幸存者以及老年与老年癌症幸存者中实施ACA后CRMU的估计变化。结果共鉴定出6176名18至64岁的癌症幸存者和4100名65至74岁的癌症幸存者。在DID分析中，收入低于联邦贫困线250％的18至64岁癌症幸存者的CRMU降低了8.33个百分点（95％置信区间，3.06-13.6 PP； P = .002） （FPL）与收入超过FPL 400％的人相比。与收入低于FPL的400％的65至74岁的癌症幸存者相比，年龄在55至64岁的癌症幸存者有所减少（-9.35 PP； 95％置信区间为-15.6至-3.14 PP [P = .003] ）。结论在低收入，非老年癌症幸存者中，与ACA相关的CRMU减少。ACA可以改善这一弱势人群的医疗保健机会和负担能力。与收入低于联邦贫困线（FPL）250％的年龄在18至64岁的癌症幸存者相比，CRMU降低了33个百分点（95％置信区间，3.06-13.6 PP； P = .002）收入超过FPL的400％。与收入低于FPL的400％的65至74岁的癌症幸存者相比，年龄在55至64岁的癌症幸存者有所减少（-9.35 PP； 95％置信区间为-15.6至-3.14 PP [P = .003] ）。结论在低收入，非老年癌症幸存者中，与ACA相关的CRMU减少。ACA可以改善这一弱势人群的医疗保健服务和负担能力。与收入低于联邦贫困线（FPL）250％的年龄在18至64岁的癌症幸存者相比，CRMU降低了33个百分点（95％置信区间，3.06-13.6 PP； P = .002）收入超过FPL的400％。与收入低于FPL的400％的65至74岁的癌症幸存者相比，年龄在55至64岁的癌症幸存者有所减少（-9.35 PP； 95％置信区间为-15.6至-3.14 PP [P = .003] ）。结论在低收入，非老年癌症幸存者中，与ACA相关的CRMU减少。ACA可以改善这一弱势人群的医疗保健机会和负担能力。FPL的400％。与收入低于FPL的400％的65至74岁的癌症幸存者相比，年龄在55至64岁的癌症幸存者有所减少（-9.35 PP； 95％置信区间为-15.6至-3.14 PP [P = .003] ）。结论在低收入，非老年癌症幸存者中，与ACA相关的CRMU减少。ACA可以改善这一弱势人群的医疗保健机会和负担能力。FPL的400％。与收入低于FPL的400％的65至74岁的癌症幸存者相比，年龄在55至64岁的癌症幸存者有所减少（-9.35 PP； 95％置信区间为-15.6至-3.14 PP [P = .003] ）。结论在低收入，非老年癌症幸存者中，与ACA相关的CRMU减少。ACA可以改善这一弱势人群的医疗保健机会和负担能力。