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Weiwei X, Ping Z. Comment on Fajarini et al. (2024) 'Effects of advanced practice nurses on health-care costs, quality of care, and patient well-being: A meta-analysis of randomized controlled trials'. Int J Nurs Stud 2025; 163:105001. [PMID: 39843268 DOI: 10.1016/j.ijnurstu.2025.105001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Accepted: 01/11/2025] [Indexed: 01/24/2025]
Affiliation(s)
- Xiao Weiwei
- Outpatient Department, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, 20 Yudong Road, Zhifu District, Yantai City, Shandong Province, China
| | - Zhang Ping
- Pediatrics, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, 20 Yudong Road, Zhifu District, Yantai City, Shandong Province, China.
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Jazowski SA, Nayak RK, Dusetzina SB. The high costs of anticancer therapies in the USA: challenges, opportunities and progress. Nat Rev Clin Oncol 2024; 21:888-899. [PMID: 39367130 PMCID: PMC11848938 DOI: 10.1038/s41571-024-00948-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2024] [Indexed: 10/06/2024]
Abstract
The USA spent $99 billion on orally administered and clinician-administered anticancer therapies (excluding supportive care) in 2023 and spending is projected to increase to $180 billion by 2028. This increased spending on anticancer therapies largely reflects the high launch prices of novel therapeutics and increases in the prices of existing products, even in the absence of new evidence of clinical benefit or changes in use. Consequently, high prices have impeded Americans' access to and affordability of necessary anticancer therapies and thus increased their risk of cost-related non-adherence, cancer recurrence and mortality. To address the rising prices and concerns regarding Americans' spending on anticancer therapies, state and federal governments have, over the past decade, enacted legislation that caps out-of-pocket spending, expands subsidies and requires drug price negotiations. In this Perspective, we summarize US policies aimed to lower the costs of anticancer therapies, discuss the implications of such reforms and propose additional solutions needed to reduce costs and increase value.
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Affiliation(s)
- Shelley A Jazowski
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rahul K Nayak
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
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Shih YCT, Yabroff KR, Bradley C. The utility of value frameworks in cost communications: making them real for patients. J Natl Cancer Inst 2024; 116:1411-1413. [PMID: 39003520 PMCID: PMC11378310 DOI: 10.1093/jnci/djae156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024] Open
Affiliation(s)
- Ya-Chen Tina Shih
- University of California Los Angeles Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, School of Medicine, Los Angeles, CA, USA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Cathy Bradley
- University of Colorado Comprehensive Cancer Center and Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
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Sharma B, Mehta A, Farooqui HH, Negandhi H, Selvaraj S. Impact of the Drug Prices Control Order (2013) on the Utilization of Anticancer Medicines in India: An Interrupted Time-Series Analysis. Cureus 2022; 14:e26367. [PMID: 35911346 PMCID: PMC9329597 DOI: 10.7759/cureus.26367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives The National Pharmaceutical Pricing Authority introduced a series of Drug Prices Control Orders since 1970 to regulate the prices of essential medicines in India. This study evaluated the impact of the Drug Prices Control Order of 2013 on the utilization of anticancer medicines in the Indian private sector. Methods We used monthly sales audit data for a period of 2012-15, provided by Intercontinental Medical Statistics (IMS) Health. Through interrupted time series design and segmented regression models, we estimated the change in utilization of anticancer medicines following the drug pricing policy implementation. Results Of 1556 anticancer drug packs, 22.3% (n= 347) were price-controlled. The policy led to an immediate monthly reduction of 27.3% (95% CI -38.6%, -13.9%; p=0.001) and a long-term monthly reduction of 0.7% (95% CI -1.6%, 0.3%; p=0.16) in price-controlled formulation’s utilization. In the final study month, the price-controlled formulation’s utilization was 5.03 thousand standard units lower than what would have been expected without the policy. Melphalan showed the highest immediate reduction, and alpha-interferon showed the highest long-term reduction in utilization. Conclusion Drug prices control order 2013 caused an immediate and long-term decline in the utilization of anticancer medicines in the Indian private sector. However, study data was limited to a specific part of the Indian anticancer drug market, which must be considered when interpreting findings.
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Pharmacoepidemiology for oncology clinical practice: Foundations, state of the art and perspectives. Therapie 2022; 77:229-240. [DOI: 10.1016/j.therap.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022]
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Sulley S, Abimbola S, Ndanga M. Acute lymphocytic leukemia severity and mortality hospitalizations in the United States: A population-based study. Int J Health Sci (Qassim) 2022; 16:4-10. [PMID: 35599942 PMCID: PMC9092538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives The objective of the study was to understand the relationship between social and economic indicators of health and its association with hospitalization severity and mortality risk among ALL patients. Methods In this retrospective study, hospitalizations with primary and secondary diagnosis were identified using International Classification of Diseases (ICD 10) codes (C91.00, C91.01, C91.02) of ALL in the National Inpatient Sample (NIS) between 2016 and 2018. Hospitalization outcomes such as LOS, mortality, severity and mortality risk, cost, diagnosis (NDX), number of procedures (NPR) were analyzed by race and ethnicity, household income, and patient location among patients with primary and secondary ALL diagnoses. Results A total of 158090 hospitalizations were identified as meeting the inclusion criteria without missing cases with a primary or secondary diagnosis of ALL using ICD-10 codes. Severity risk at presentation varied from one area to the next, with the highest rate (per 10K) presentations in the New England region for both extreme likelihood (778) and extreme loss of function (2198) at presentation. Mortality and severity among uninsured patients were the second highest (614, 2193) compared to other payers. Extreme mortality risk at presentation was higher among African American (711), Caucasian (648), and Native American (612) populations compared to other racial and ethnic groups. Conclusion The findings of this study suggest a relative decrease in presentation rate by year and higher mortality among specific groups-based demographics indicators. It also confirms the impact of advanced therapeutics and improved severity and mortality among younger populations with ALL compared to the older population.
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Affiliation(s)
- Saanie Sulley
- Health Informatics, Independent Researcher, Washington DC, USA,Address for correspondence: Saanie Sulley, Health Informatics, Independent Researcher, Washington DC, USA. E-mail:
| | - Saka Abimbola
- Translational Research, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Memory Ndanga
- Health Informatics, Rutgers University, Piscataway, NJ, USA
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Taylor EA, Buttorff C, Pegany V, Petersen L, Mangiaracino A, Wolf E, Lang L. Access to High-Cost Medications After a Cap on Monthly Out-of-Pocket Spending in California. JAMA Netw Open 2021; 4:e2126642. [PMID: 34559233 PMCID: PMC8463936 DOI: 10.1001/jamanetworkopen.2021.26642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study evaluates the association of a cap on monthly out-of-pocket spending on high-cost drugs with use of these drugs and out-of-pocket spending in California in 2015 and 2016.
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Affiliation(s)
| | | | | | | | - Allison Mangiaracino
- Health Plan Regulatory and Exchange Operations, Kaiser Permanente, Sacramento, California
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Dusetzina SB, Huskamp HA, Jazowski SA, Winn AN, Basch E, Keating NL. Comparison of Anticancer Medication Use and Spending Under US Oncology Parity Laws With and Without Out-of-Pocket Spending Caps. JAMA HEALTH FORUM 2021; 2:e210673. [PMID: 35977314 PMCID: PMC8796987 DOI: 10.1001/jamahealthforum.2021.0673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/29/2021] [Indexed: 11/14/2022] Open
Abstract
Question How does orally administered anticancer medication (OAM) use and spending differ among states that adopted parity with vs without out-of-pocket spending caps? Findings In this cohort study of 23 states and 207 579 OAM prescription fills, out-of-pocket spending caps were associated with higher OAM use and lower out-of-pocket spending by $831 per OAM prescription fill among the highest spenders. Savings were larger for enrollees in states with caps that applied predeductible and postdeductible vs those that applied postdeductible only. Meaning Caps may offer improved financial protection for the highest spenders without increasing mean health plan spending on OAMs. Importance By 2020, nearly all states had adopted oncology parity laws in the US, ensuring that patients in fully insured private health plans pay no more for orally administered anticancer medications (OAMs) than infused therapies. Between 2013 and mid-2017, 11 states implemented parity with out-of-pocket spending caps, which may further reduce patient out-of-pocket spending. Objective To compare OAM uptake and out-of-pocket and health plan spending on OAMs in states with parity with and without spending caps, as well as to assess out-of-pocket spending for caps that apply predeductible vs postdeductible. Design, Setting, and Participants This cohort study analyzed OAM users enrolled in commercial health plans offered by Aetna, Humana, and United Healthcare in the US from 2011 to 2017, aggregated by the Health Care Cost Institute, using difference-in-difference-in-differences (DDD) analysis. Data analysis was conducted between June and August 2020. Exposures Time (before vs after parity), whether the state parity law included an out-of-pocket spending cap, and whether the plan was fully insured (subject to parity) or self-funded (not subject to parity). Among states with caps, out-of-pocket spending was also compared by whether the cap was applied predeductible and postdeductible vs only postdeductible. Main Outcomes and Measures Monthly OAM prescription fills per 100 000 enrollees, per-OAM prescription-fill out-of-pocket spending, and annual per-user health plan spending on OAMs. Results In this study of 23 states (11 with caps and 12 without) and 207 579 OAM prescription fills, caps were associated with a modest increase in OAM use (DDD, 7.40 [95% CI, 3.41-11.39] per 100 000 enrollees). There was no difference in mean out-of-pocket spending comparing fully insured and self-funded enrollees in states with vs without caps (DDD, −$17 [95% CI, −$57 to $24), but caps were associated with lower spending among OAM users in the 95th percentile of out-of-pocket spending by $831 (95% CI, −$871 to −$791) per OAM prescription fill. Caps applied predeductible were associated with greater out-of-pocket savings relative to caps applied only postdeductible. This included per-OAM prescription-fill savings at the 75th, 90th, and 95th percentiles. Postparity, mean annual spending on OAMs among users was $113 589 in states without caps and $102 252 in states with caps, with no differences between groups (DDD, $9799 [95% CI, −$4230 to $23 829). Conclusions and Relevance In this cohort study, among states adopting oncology parity laws between 2013 and 2017, mean out-of-pocket spending per OAM prescription fill and mean health plan spending among OAM users was similar in states with and without caps. However, enrollees in states with parity plus out-of-pocket caps had greater reductions in out-of-pocket spending among the highest spenders. Caps may offer improved financial protection for the highest spenders without increasing mean health plan spending on OAMs.
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Affiliation(s)
- Stacie B. Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Shelley A. Jazowski
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Aaron N. Winn
- School of Pharmacy, Medical College of Wisconsin, Milwaukee
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Cancer Center, Medical College of Wisconsin, Milwaukee
| | - Ethan Basch
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Division of Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
- Associate Editor, JAMA
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
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Jella TK, Acuña AJ, Samuel LT, Schwarzkopf R, Fehring TK, Kamath AF. Medicare Physician Fee Reimbursement for Revision Total Knee Arthroplasty Has Not Kept Up with Inflation from 2002 to 2019. J Bone Joint Surg Am 2021; 103:778-785. [PMID: 33269896 DOI: 10.2106/jbjs.20.01034] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As orthopaedic physician fees continue to come under scrutiny by the U.S. Centers for Medicare & Medicaid Services (CMS), there is a continued need to evaluate trends in reimbursement rates across contemporary time intervals. Although substantially lower work relative value units (RVUs) have been previously demonstrated for septic revision total knee arthroplasty (TKA) compared with aseptic revisions, to our knowledge, there has been no corresponding analysis comparing total physician fees. Therefore, the purpose of our study was to analyze temporal trends in Medicare physician fees for septic and aseptic revision TKAs. METHODS Current Procedural Terminology (CPT) codes related to septic 1-stage and 2-stage revision TKAs and aseptic revision TKAs were categorized. From 2002 to 2019, the facility rates of physician fees associated with each CPT code were obtained from the CMS Physician Fee Schedule Look-Up Tool. Monetary data from Medicare Administrative Contractors at 85 locations were used to calculate nationally representative means. All total physician fee values were adjusted for inflation and were translated to 2019 U.S. dollars using Consumer Price Index data from the U.S. Bureau of Labor Statistics. Cumulative annual percentage changes and compound annual growth rates (CAGRs) were computed utilizing adjusted physician fee data. RESULTS After adjusting for inflation, the total mean Medicare reimbursement (and standard deviation) for aseptic revision TKA decreased 24.83% ± 3.65% for 2-component revision and 24.21% ± 3.68% for 1-component revision. The mean septic revision TKA total Medicare reimbursement declined 23.29% ± 3.73% for explantation and 33.47% ± 3.24% for reimplantation. Both the dollar amount (p < 0.0001) and the percentage (p < 0.0001) of the total Medicare reimbursement decline for septic revision TKA were significantly greater than the decline for aseptic revision TKA. CONCLUSIONS Septic revision TKAs have been devalued at a rate greater than their aseptic counterparts over the past 2 decades. Coupled with our findings, the increased resource utilization of septic revision TKAs may result in financial barriers for physicians and subsequently may reduce access to care for patients with periprosthetic joint infections. CLINICAL RELEVANCE The devaluation of revision TKAs may result in reduced patient access to infection management at facilities unable to bear the financial burden of these procedures.
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Affiliation(s)
- Tarun K Jella
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, New York University Langone Health Medical Center, New York, NY
| | | | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Spargo A, Yost C, Squires P, Raju A, Schroader B, Brown JD. The effects of oral anticancer parity laws on out-of-pocket spending and adherence among commercially insured patients with chronic myeloid leukemia. J Manag Care Spec Pharm 2021; 27:554-564. [PMID: 33908275 PMCID: PMC10391131 DOI: 10.18553/jmcp.2021.27.5.554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Over the past 12 years, 43 states and Washington DC have implemented oral anticancer medication parity laws in response to the burden of pharmacy cost sharing. Parity laws are designed to provide equal coverage and cost sharing between orally and parenterally administered anticancer medications for patients in commercial, fully insured health plans (FIHPs). However, there is considerable state-level variation in the requirements to achieve compliance with parity laws, and the clinical and economic effectiveness of parity is not fully known. OBJECTIVES: To (a) understand the impact of parity laws on out-of-pocket (OOP) spending and adherence to tyrosine kinase inhibitors (TKI) among commercially insured patients with chronic myeloid leukemia (CML) and (b) compare these effects across states with and without per prescription or per 30-day OOP spending limits as part of their parity laws. METHODS: Patients aged 18-64 years with CML, at least 1 pharmacy claim for a TKI, and residence in a state that implemented oral anticancer parity legislation between January 1, 2007, and January 1, 2017, were identified from the IBM MarketScan Commercial Claims and Encounters database. A propensity score-weighted difference-in-difference approach was used to measure the impact of parity on OOP spending and adherence in the 6 months after the first pharmacy claim for a TKI (index date) for patients enrolled in FIHPs (subject to parity) and self-funded health plans (SFHPs; exempt from parity). OOP spending was standardized to a 30-day equivalent amount and adjusted to 2017 US dollars. Adherence was assessed using the proportion of days covered (PDC), and patients were categorized as adherent with PDC ≥ 0.80. RESULTS: Of 1,887 patients initiating a TKI before or after their state's parity law, 678 (35.9%) were enrolled in FIHPs (480 before vs 198 after parity), and 1,209 (64.1%) were enrolled in SFHPs (688 before vs 521 after parity). Implementation of parity laws was not associated with any changes in mean OOP spending; however, it was associated with a reduced likelihood of paying $0 per 30 days across all states (adjusted difference-in-difference [aDD] OR = 0.662; 95% CI = 0.535-0.820) and states without OOP spending limits (aDD OR = 0.654; 95% CI = 0.508-0.848), but not in states with limits. Nonsignificant but directionally opposite changes at each end of the OOP spending distribution were observed for states with and without OOP spending limits, with increased spending observed at the 75th, 90th, and 95th percentiles in states without limits. Mean PDC and adherence showed a nonsignificant increase among FIHP and SFHP patients across all states, states with limits, and states without limits. CONCLUSIONS: Oral anticancer parity laws are not associated with reduced OOP spending or improved adherence in a commercially insured sample of patients with CML. These findings were consistent for states that included OOP spending limits as a component of their parity laws. DISCLOSURES: This study did not receive any external funding. Spargo, Yost, Raju, and Schroader are or were employees of Xcenda, which receives contracts from various industry partners unrelated to this work. There are no other conflicts of interest to disclose.
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Affiliation(s)
- Andrew Spargo
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, and Xcenda, Palm Harbor, FL
| | - Christopher Yost
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, and Xcenda, Palm Harbor, FL
| | - Patrick Squires
- Department of Pharmaceutical Outcomes & Policy and Center for Drug Evaluation & Safety, University of Florida College of Pharmacy, Gainesville, FL
| | | | | | - Joshua D Brown
- Department of Pharmaceutical Outcomes & Policy and Center for Drug Evaluation & Safety, University of Florida College of Pharmacy, Gainesville, FL
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Iragorri N, de Oliveira C, Fitzgerald N, Essue B. The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review. Curr Oncol 2021; 28:1216-1248. [PMID: 33804288 PMCID: PMC8025828 DOI: 10.3390/curroncol28020117] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Out-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care. METHODS A systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs. RESULTS Among all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15-400 in Canada, USD 4-609 in Western Europe, and USD 58-438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40-71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively. CONCLUSIONS We found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care.
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Affiliation(s)
- Nicolas Iragorri
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
| | - Claire de Oliveira
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M6J 1H4, Canada
| | | | - Beverley Essue
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
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Liang MI, Chen L, Hershman DL, Hillyer GC, Huh WK, Guyton A, Wright JD. Total and out-of-pocket costs for PARP inhibitors among insured ovarian cancer patients. Gynecol Oncol 2021; 160:793-799. [PMID: 33375989 PMCID: PMC7902421 DOI: 10.1016/j.ygyno.2020.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/15/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate total and out-of-pocket costs for poly(ADP-ribose) polymerase (PARP) inhibitors and differences based on insurance characteristics. METHODS We identified ovarian cancer patients who were prescribed niraparib, olaparib, or rucaparib from the MarketScan (2014-2017) and Surveillance, Epidemiology, and End Results (SEER)-Medicare (2014-2016) databases. Drug costs were estimated for a 30-day supply. Descriptive statistics and Wilcoxon rank sum tests were performed. RESULTS 590 commercially insured beneficiaries from MarketScan and 213 SEER-Medicare beneficiaries were prescribed PARP inhibitors for a median 112 days. For commercially insured beneficiaries, median total cost was $13,342 (IQR $12,022-$14,256). Median out-of-pocket cost was $44 (IQR $0-$120) and PARP inhibitors accounted for a median 90.8% of patients' total out-of-pocket drug spending. High-deductible health plan was not associated with higher out-of-pocket costs (N = 570; median $0 vs. $45, P = 0.87). For SEER-Medicare beneficiaries, median total cost was $12,798 (IQR $11,704-$13,180). Median out-of-pocket cost was $370 (IQR $2-$1234) and PARP inhibitors accounted for a median 99.0% of patients' total out-of-pocket drug spending. Out-of-pocket costs were lower for dual-eligible patients with supplemental Medicaid prescription coverage (N = 209; median $1 vs. $911, P < 0.001). CONCLUSIONS Although insurers are responsible for a large proportion of PARP inhibitor costs, out-of-pocket costs for PARP inhibitors account for a majority of patients' drug spending. SEER-Medicare beneficiaries had higher out-of-pocket costs than patients with commercial insurance, which was offset for those with supplemental Medicaid prescription coverage.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Ling Chen
- Columbia University Vagelos College of Physicians and Surgeons, United States of America
| | - Dawn L Hershman
- Columbia University Vagelos College of Physicians and Surgeons, United States of America; Mailman School of Public Health, Columbia University, United States of America; Herbert Irving Comprehensive Cancer Center of Columbia University, United States of America
| | - Grace C Hillyer
- Mailman School of Public Health, Columbia University, United States of America; Herbert Irving Comprehensive Cancer Center of Columbia University, United States of America
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Allison Guyton
- Department of Pharmacy, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Jason D Wright
- Columbia University Vagelos College of Physicians and Surgeons, United States of America; Herbert Irving Comprehensive Cancer Center of Columbia University, United States of America
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Abstract
BACKGROUND The strain on public resources to meet the healthcare needs of populations through publicly-provided health insurance programmes is increasing and many governments turn to private health insurance (PHI) to ease the pressure on government budgets. With the goal of improving access to basic health care for citizens through PHI programmes, several high-income countries have developed strong regulations for PHI schemes. Low- and middle-income countries have the opportunity to learn from this experience to optimise PHI. If poorly regulated, PHI can hardly achieve an adequate quantity or quality of population coverage, as can be seen in the USA where a third of adults younger than 65 years of age have no insurance, sporadic coverage or coverage that exposes them to high out-of-pocket healthcare costs. OBJECTIVES To assess the effects of policies that regulate private health insurance on utilisation, quality, and cost of health care provided. SEARCH METHODS In November 2019 we searched CENTRAL; MEDLINE; Embase; Sociological Abstracts and Social Services Abstracts; ICTRP; ClinicalTrials.gov; and Web of Science Core Collection for papers that have cited the included studies. This complemented the search conducted in February 2017 in IBSS; EconLit; and Global Health. We also searched selected grey literature databases and web-sites. SELECTION CRITERIA: Randomised trials, non-randomised trials, interrupted time series (ITS) studies, and controlled before-after (CBA) studies conducted in any population or setting that assessed one or more of the following interventions that governments use to regulate private health insurance: legislation and licensing, monitoring, auditing, and intelligence. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of the evidence resolving discrepancies by consensus. We planned to summarise the results (using random-effects or fixed-effect meta-analysis) to produce an overall summary if an average intervention effect across studies was considered meaningful, and we would have discussed the implications of any differences in intervention effects across studies. However, due to the nature of the data obtained, we have provided a narrative synthesis of the findings. MAIN RESULTS We included seven CBA studies, conducted in the USA, and that directly assessed state laws on cancer screening. Only for-profit PHI schemes were addressed in the included studies and no study addressed other types of PHI (community and not for-profit). The seven studies were assessed as having 'unclear risk' of bias. All seven studies reported on utilisation of healthcare services, and one study reported on costs. None of the included studies reported on quality of health care and patient health outcomes. We assessed the certainty of evidence for patient health outcomes, and utilisation and costs of healthcare services as very low. Therefore, we are uncertain of the effects of government mandates on for-profit PHI schemes. AUTHORS' CONCLUSIONS Our review suggests that, from currently available evidence, it is uncertain whether policies that regulate private health insurance have an effect on utilisation of healthcare services, costs, quality of care, or patient health outcomes. The findings come from studies conducted in the USA and might therefore not be applicable to other countries; since the regulatory environment could be different. Studies are required in countries at different income levels because the effects of government regulation of PHI are likely to differ across these income and health system settings. Further studies should assess the different types of regulation (including regulation and licensing, monitoring, auditing, and intelligence). While regulatory research on PHI remains relatively scanty, future research can draw on the rich body of research on the regulation of other health financing interventions such as user fees and results-based provider payments.
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Affiliation(s)
- Nkengafac Villyen Motaze
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Primus Che Chi
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Pierre Ongolo-Zogo
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Jean Serge Ndongo
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town , Cape Town, South Africa
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14
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Shen Y, Noguchi H. Impacts of anticancer drug parity laws on mortality rates. Soc Sci Med 2021; 272:113714. [PMID: 33545495 DOI: 10.1016/j.socscimed.2021.113714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
This study investigates the impacts of anticancer drug parity laws on mortality rates in the United States using a difference-in-differences approach. Using data from 2004 to 2017 Compressed Mortality Files, we show that the anticancer drug parity laws reduce the mortality rate for head/neck malignant cancers but have no impact on malignant cancers of other types. We also rule out an insurance expansion channel that may influence the relationship between anticancer drug parity laws and malignant cancer mortality. Our results are robust to various specifications and falsification tests. Our findings imply that providing equal access to oral anticancer drugs is an effective tool for the prevention of premature mortality.
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Affiliation(s)
- Yichen Shen
- Graduate School of Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku, Tokyo, 169-8050, Japan.
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishi-Waseda, Shinjuku, Tokyo, 169-8050, Japan.
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15
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Dusetzina SB, Huskamp HA, Jazowski SA, Winn AN, Wood WA, Olszewski A, Basch E, Keating NL. Oral Oncology Parity Laws, Medication Use, and Out-of-Pocket Spending for Patients With Blood Cancers. J Natl Cancer Inst 2020; 112:1055-1062. [PMID: 31883008 PMCID: PMC7566334 DOI: 10.1093/jnci/djz243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/16/2019] [Accepted: 12/24/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In this study, we sought to estimate the association between oral oncology parity law adoption and anticancer medication use for patients with chronic myeloid leukemia or multiple myeloma. METHODS This was an observational study of administrative claims from 2008 to 2017. Among individuals initiating tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia or immunomodulatory drugs for multiple myeloma, we compared out-of-pocket spending, adherence, and discontinuation before and after parity among individuals in fully insured plans (subject to parity) vs self-funded plans (exempt from parity) using propensity-score weighted difference-in-differences regression models. RESULTS Among patients initiating TKIs (N = 2082) or immunomodulatory drugs (N = 3326) there were no statistically significant differences in adherence or discontinuation associated with parity. The proportion of patients with initial out-of-pocket payments of $0 increased in fully insured plans after parity from 5.7% to 46.1% for TKIs and from 10.9% to 48.8% for immunomodulatory drugs. Relative to changes in self-funded plans, those in fully insured plans were 4.27 (95% CI = 2.20 to 8.27) times as likely to pay nothing for TKIs and 1.96 (95% CI = 1.40 to 2.73) times as likely to pay nothing for immunomodulatory drugs after parity. Similarly, the proportion paying more than $100 decreased from 30.3% to 24.7% for TKIs and 30.6% to 27.5% for immunomodulatory drugs in fully insured plans after parity. Relative to changes in self-funded plans, those in fully insured plans were 0.74 (95% CI = 0.54 to 1.01) times as likely to pay more than $100 for TKIs and 0.85 (95% CI = 0.68 to 1.06) times as likely to pay more than $100 for immunomodulatory drugs after parity. CONCLUSIONS Among patients initiating TKIs or immunomodulatory drugs, parity was not associated with better adherence or less discontinuation of therapy but yielded decreased patient out-of-pocket payments for some patients.
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Affiliation(s)
- Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt-Ingram Comprehensive Cancer Center, Nashville, TN, USA
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Shelley A Jazowski
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Aaron N Winn
- Medical College of Wisconsin, School of Pharmacy, Milwaukee, WI, USA
- Center for Advancement of Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William A Wood
- School of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Ethan Basch
- School of Medicine, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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16
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Jazowski SA, Dusetzina SB. Addressing cost-related nonadherence to oral anticancer medications through health policy reform: Challenges and opportunities. Cancer 2020; 126:3613-3616. [PMID: 32438468 DOI: 10.1002/cncr.32944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Shelley A Jazowski
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Vanderbilt-Ingram Comprehensive Cancer Center, Nashville, Tennessee, USA
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17
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Yeung K, Barthold D, Dusetzina SB, Basu A. Patient and Plan Spending after State Specialty-Drug Out-of-Pocket Spending Caps. N Engl J Med 2020; 383:558-566. [PMID: 32757524 DOI: 10.1056/nejmsa1910366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Specialty drugs are used to treat complex or life-threatening conditions, often at high financial costs to both patients and health plans. Three states - Delaware, Louisiana, and Maryland - passed legislation to cap out-of-pocket payments for specialty drugs at $150 per prescription. A concern is that these caps could shift costs to health plans, increasing insurance premiums. Estimates of the effect of the caps on patient and health-plan spending could inform future policies. METHODS We analyzed a sample that included 27,161 persons under 65 years of age who had rheumatoid arthritis, multiple sclerosis, hepatitis C, psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis and who were in commercial health plans from 2011 through 2016 that were administered by three large nationwide insurers. The primary outcome was the change in out-of-pocket spending among specialty-drug users who were in the 95th percentile for spending on specialty drugs. Other outcomes were changes in mean out-of-pocket and health-plan spending for specialty drugs, nonspecialty drugs, and nondrug health care and utilization of specialty drugs. We compared outcomes in the three states that enacted caps with neighboring control states that did not, 3 years before and up to 3 years after enactment of the spending cap. RESULTS Caps were associated with an adjusted change in out-of-pocket costs of -$351 (95% confidence interval, -554 to -148) per specialty-drug user per month, representing a 32% reduction in spending, among users in the 95th percentile of spending on specialty drugs. This finding was supported by multiple sensitivity analyses. Caps were not associated with changes in other outcomes. CONCLUSIONS Caps for spending on specialty drugs were associated with substantial reductions in spending on specialty drugs among patients with the highest out-of-pocket costs, without detectable increases in health-plan spending, a proxy for future insurance premiums. (Funded by the Robert Wood Johnson Foundation Health Data for Action Program.).
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Affiliation(s)
- Kai Yeung
- From Kaiser Permanente Washington Health Research Institute (K.Y.) and the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington (K.Y., D.B., A.B.), Seattle; the Department of Health Policy, Vanderbilt University School of Medicine, and Vanderbilt-Ingram Cancer Center, Nashville (S.B.D.); and the National Bureau of Economic Research, Cambridge, MA (A.B.)
| | - Douglas Barthold
- From Kaiser Permanente Washington Health Research Institute (K.Y.) and the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington (K.Y., D.B., A.B.), Seattle; the Department of Health Policy, Vanderbilt University School of Medicine, and Vanderbilt-Ingram Cancer Center, Nashville (S.B.D.); and the National Bureau of Economic Research, Cambridge, MA (A.B.)
| | - Stacie B Dusetzina
- From Kaiser Permanente Washington Health Research Institute (K.Y.) and the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington (K.Y., D.B., A.B.), Seattle; the Department of Health Policy, Vanderbilt University School of Medicine, and Vanderbilt-Ingram Cancer Center, Nashville (S.B.D.); and the National Bureau of Economic Research, Cambridge, MA (A.B.)
| | - Anirban Basu
- From Kaiser Permanente Washington Health Research Institute (K.Y.) and the Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington (K.Y., D.B., A.B.), Seattle; the Department of Health Policy, Vanderbilt University School of Medicine, and Vanderbilt-Ingram Cancer Center, Nashville (S.B.D.); and the National Bureau of Economic Research, Cambridge, MA (A.B.)
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18
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Dean LT, George M, Lee KT, Ashing K. Why individual-level interventions are not enough: Systems-level determinants of oral anticancer medication adherence. Cancer 2020; 126:3606-3612. [PMID: 32438466 PMCID: PMC7467097 DOI: 10.1002/cncr.32946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
Nonadherence to oral anticancer medications (OAMs) in the United States is as low as 33% for some cancers. The reasons for nonadherence to these lifesaving medications are multifactorial, yet the majority of studies focus on patient-level factors influencing uptake and adherence. Individually based interventions to increase patient adherence have not been effective, and this warrants attention to factors at the payor, pharmaceutical, and clinical systems levels. Based on the authors' research and clinical experiences, this commentary brings fresh attention to the long-standing issue of OAM nonadherence, a growing quality-of-care issue, from a systems perspective. In this commentary, the key driving factors in pharmaceutical and payor systems (state and federal laws, payor/insurance companies, and pharmaceutical companies), clinical systems (hospitals and providers), and patient contexts that have trickle-down effects on patient adherence to OAMs are outlined. In the end, the authors' recommendations include examining the influence of laws governing OAM drug pricing, OAM supply, and provider reimbursement; reducing the need for prior authorization of long-approved OAMs; identifying cost-effective ways for providers to monitor nonadherence; examining issues of provider bias in OAM prescriptions; and further elucidating in which contexts patients are likely to be able to adhere. These recommendations offer a starting point for an examination of the chain of systems influencing patient adherence and may help to finally resolve persistently high levels of OAM nonadherence.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Marshalee George
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimberley T Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimlin Ashing
- City of Hope Comprehensive Cancer Center, Division of Health Equities, City of Hope, Duarte, California, USA
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19
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Winn AN, Fergestrom NM, Pezzin LE, Laud PW, Neuner JM. The impact of generic aromatase inhibitors on initiation, adherence, and persistence among women with breast cancer: Applying multi-state models to understand the dynamics of adherence. Pharmacoepidemiol Drug Saf 2020; 29:550-557. [PMID: 32196839 PMCID: PMC11363905 DOI: 10.1002/pds.4995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/13/2020] [Accepted: 02/26/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Clinical trials have clearly documented the survival benefit of aromatase inhibitors (AIs); however, many women fail to initiate (primary nonadherence) or remain adherent to AIs (secondary nonadherence). Prior studies have found that costs impact secondary nonadherence to medications but have failed to examine primary nonadherence. The purpose of this study is to examine primary and secondary adherence following the reduction in copays due to the introduction of generic AIs. METHODS Using Surveillance, Epidemiology, and End Results-Medicare data, we identified 50 054 women diagnosed with incident breast cancer between 2008 and 2013. We compare women whose copays would change and those whose would not, due to the receipt of cost-sharing subsidies before and after generics were introduced using a difference-in-difference (DinD) analysis. To examine primary and secondary nonadherence, we rely on a multistate model with four states (Not yet initiated, User, Not Using, and Death). We adjusted for baseline factors using inverse probability treatment weights and then simulated adherence for 36 months following diagnosis. RESULTS The generic introduction of AIs resulted in patients initiating AIs faster (DinD = -4.7%, 95%CI = -7.0, -2.3; patients not yet initiating treatment at 6-months), being more adherent (DinD ranging in absolute increase of 8.1%-10.4%) and being less likely to not be using the therapy (DinD range in absolute decrease of 1.2% at 6 months to 8.8% at 24 months) for women that do not receive a subsidy after generics were available. CONCLUSIONS Introduction of generic alternatives to AIs significantly reduced primary and secondary nonadherence.
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Affiliation(s)
- Aaron N Winn
- Department of Clinical Sciences, School of Pharmacy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nicole M Fergestrom
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Section of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Liliana E Pezzin
- Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Purushottam W Laud
- Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Section of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joan M Neuner
- Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Section of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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20
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Graf SA, Samples LS, Keating TM, Garcia JM. Clinical research in older adults with hematologic malignancies: Opportunities for alignment in the Veterans Affairs. Semin Oncol 2020; 47:94-101. [PMID: 32327154 DOI: 10.1053/j.seminoncol.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of hematologic malignancies in older patients is complex and, with recent and anticipated trends in demographics, increasingly common. As a large, nationally integrated medical system the Veterans Affairs has the potential to lead in research to benefit these patients. In this review we describe the evolving treatment paradigms of hematologic malignancies and how they are best fit with older patients through comprehensive evaluation of key vulnerabilities. We also discuss optimization of supportive care and navigation services to target identified risks and challenges aimed at ameliorating the patient's burden of cancer and treatment. Lastly, we discuss opportunities in design of prospective clinical trials to better align with real-world cases, thereby expanding enrollment of and applicability to older patients with hematologic malignancies.
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Affiliation(s)
- Solomon A Graf
- Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Laura S Samples
- Division of Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Jose M Garcia
- Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; VAPSHCS Geriatric Research and Education Clinical Center (GRECC), Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, WA
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21
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Han X, Zhao J, Zheng Z, de Moor JS, Virgo KS, Yabroff KR. Medical Financial Hardship Intensity and Financial Sacrifice Associated with Cancer in the United States. Cancer Epidemiol Biomarkers Prev 2020; 29:308-317. [PMID: 31941708 DOI: 10.1158/1055-9965.epi-19-0460] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND With rising costs of cancer care, this study aims to estimate the prevalence of, and factors associated with, medical financial hardship intensity and financial sacrifices due to cancer in the United States. METHODS We identified 963 cancer survivors from the 2016 Medical Expenditures Panel Survey - Experiences with Cancer. Medical financial hardship due to cancer was measured in material (e.g., filed for bankruptcy), psychological (e.g., worry about paying bills and finances), and behavioral (e.g., delaying or forgoing care due to cost) domains. Nonmedical financial sacrifices included changes in spending and use of savings. Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group (18-64 or 65+ years). RESULTS Among cancer survivors ages 18 to 64 years, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors ages 65+ years, corresponding percentages were 42.0%, 12.7%, and 4.0%, respectively. Moreover, financial sacrifices due to cancer were more common in survivors ages 18 to 64 years (54.2%) than in survivors 65+ years (38.4%; P < 0.001). Factors significantly associated with hardship intensity in multivariable analyses included low income and educational attainment, racial/ethnic minority, comorbidity, lack of private insurance coverage, extended employment change, and recent cancer treatment. Most were also significantly associated with financial sacrifices. CONCLUSIONS Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors. IMPACT Efforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.
| | - Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Katherine S Virgo
- Department of Health Policy and Management, Emory University, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
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22
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Graf SA, Samples LS, Keating TM, Garcia JM. Clinical research in older adults with hematologic malignancies: Opportunities for alignment in the Veterans Affairs. Semin Oncol 2019; 46:341-345. [PMID: 31606147 DOI: 10.1053/j.seminoncol.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022]
Abstract
Management of hematologic malignancies in older patients is complex and, with recent and anticipated trends in demographics, increasingly common. As a large, nationally integrated medical system the Veterans Affairs has the potential to lead in research to benefit these patients. In this review we describe the evolving treatment paradigms of hematologic malignancies and how they are best fit with older patients through comprehensive evaluation of key vulnerabilities. We also discuss optimization of supportive care and navigation services to target identified risks and challenges aimed at ameliorating the patient's burden of cancer and treatment. Lastly, we discuss opportunities in design of prospective clinical trials to better align with real-world cases, thereby expanding enrollment of and applicability to older patients with hematologic malignancies.
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Affiliation(s)
- Solomon A Graf
- Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Laura S Samples
- Division of Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Jose M Garcia
- Veterans Affairs Puget Sound Health Care System (VAPSHCS), Seattle, WA; VAPSHCS Geriatric Research and Education Clinical Center (GRECC), Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, WA
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23
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Neff I. Beyond Parity and Toward Socially Owned Anticancer Drug Research. JAMA Oncol 2019; 5:1260-1261. [PMID: 31318397 DOI: 10.1001/jamaoncol.2019.2291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ian Neff
- Oregon Health & Science University-Portland State University School of Public Health, Portland.,Center for Hematologic Malignancies, Oregon Health & Science University, Portland
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24
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Williams SB, Shan Y, Ray-Zack MD, Hudgins HK, Jazzar U, Tyler DS, Freedland SJ, Swanson TA, Baillargeon JG, Hu JC, Kaul S, Kamat AM, Gore JL, Mehta HB. Comparison of Costs of Radical Cystectomy vs Trimodal Therapy for Patients With Localized Muscle-Invasive Bladder Cancer. JAMA Surg 2019; 154:e191629. [PMID: 31166593 DOI: 10.1001/jamasurg.2019.1629] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Earlier studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days. Objective To compare the 1-year costs associated with trimodal therapy vs radical cystectomy, accounting for survival and intensity effects on total costs. Design, Setting, and Participants This population-based cohort study used the US Surveillance, Epidemiology, and End Results-Medicare database and included 2963 patients aged 66 to 85 years who had received a diagnosis of clinical stage T2 to T4a muscle-invasive bladder cancer from January 1, 2002, through December 31, 2011. The data analysis was performed from March 5, 2018, through December 4, 2018. Main Outcomes and Measures Total Medicare costs within 1 year of diagnosis following radical cystectomy vs trimodal therapy were compared using inverse probability of treatment-weighted propensity score models that included a 2-part estimator to account for intrinsic selection bias. Results Of 2963 participants, 1030 (34.8%) were women, 2591 (87.4%) were white, 129 (4.4%) were African American, and 98 (3.3%) were Hispanic. Median costs were significantly higher for trimodal therapy than radical cystectomy in 90 days ($83 754 vs $68 692; median difference, $11 805; 95% CI, $7745-$15 864), 180 days ($187 162 vs $109 078; median difference, $62 370; 95% CI, $55 581-$69 160), and 365 days ($289 142 vs $148 757; median difference, $109 027; 95% CI, $98 692-$119 363), respectively. Outpatient care, radiology, medication expenses, and pathology/laboratory costs contributed largely to the higher costs associated with trimodal therapy. On inverse probability of treatment-weighted adjusted analyses, patients undergoing trimodal therapy had $136 935 (95% CI, $122 131-$152 115) higher mean costs compared with radical cystectomy 1 year after diagnosis. Conclusions and Relevance Compared with radical cystectomy, trimodal therapy was associated with higher costs among patients with muscle-invasive bladder cancer. The differences in costs were largely attributed to medication and radiology expenses associated with trimodal therapy. Extrapolating cost figures resulted in a nationwide excess spending of $468 million for trimodal therapy compared with radical cystectomy for patients who received a diagnosis of bladder cancer in 2017.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Yong Shan
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Mohamed D Ray-Zack
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Hogan K Hudgins
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Usama Jazzar
- Division of Urology, Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
| | | | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston
| | - Jacques G Baillargeon
- Sealy Center on Aging, Division of Epidemiology, Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, New York
| | - Sapna Kaul
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston
| | - John L Gore
- Department of Urology, University of Washington, Seattle
| | - Hemalkumar B Mehta
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston
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Ellis SD, Geana M, Mackay CB, Moon DJ, Gills J, Zganjar A, Brekke G, Thrasher JB, Griebling TL. Science in the Heartland: Exploring determinants of offering cancer clinical trials in rural-serving community urology practices. Urol Oncol 2019; 37:529.e9-529.e18. [PMID: 30935846 PMCID: PMC6661185 DOI: 10.1016/j.urolonc.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/24/2019] [Accepted: 03/10/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Engaging community urologists in referring patients to clinical trials could increase the reach of cancer trials and, ultimately, alleviate cancer disparities. We sought to identify determinants of referring patients to clinical trials among urology practices serving rural communities. METHODS We conducted semistructured qualitative interviews based on the Theoretical Domains Framework at nonmetropolitan urology practices located in communities offering urological cancer trials. Participants were asked to consider barriers and strategies that might support engaging their patients in discussions about urological cancer clinical trials and referring them appropriately. Recorded interviews were transcribed and coded using template analysis. RESULTS Most participants were not aware of available trials and had no experience with trial referral. Overall, participants held positive attitudes toward clinical trials and recognized their potential roles in accrual, but limited local resources reduced opportunities for offering trials. Most participants expressed a need for increased human, financial, and other resources to support this role. Many participants requested information and training to increase their knowledge of clinical trials and confidence in offering them to patients. Participants highlighted the need to build efficient pathways to identify available trials, match eligible patients, and facilitate communication and collaboration with cancer centers for patient follow-up and continuity of care. CONCLUSIONS With adequate logistical and informational support, community urology practices could play an important role in clinical trial accrual, advancing cancer research and increasing treatment options for rural cancer patients. Future studies should explore the effectiveness of strategies to optimize urology practices' role in clinical trial accrual.
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Affiliation(s)
- Shellie D Ellis
- Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS; University of Kansas Cancer Center, Kansas City, KS.
| | - Mugur Geana
- School of Journalism and Mass Communications, University of Kansas, Lawrence, KS; University of Kansas Cancer Center, Kansas City, KS
| | - Christine B Mackay
- Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS; University of Kansas Cancer Center, Kansas City, KS
| | - Deborah J Moon
- Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS
| | - Jessie Gills
- Department of Urology, Louisiana State University, New Orleans, LA
| | - Andrew Zganjar
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS
| | - Gayle Brekke
- Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS
| | - J Brantley Thrasher
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS
| | - Tomas L Griebling
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS; The Landon Center on Aging, Kansas University Medical Center, Kansas City, KS
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Winn AN, Maciejewski ML, Dusetzina SB. Identifying Heterogeneous Treatment Effects of Drug Policy in Quasi-experimental Settings. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dean LT, Moss SL, Rollinson SI, Frasso Jaramillo L, Paxton RJ, Owczarzak JT. Patient recommendations for reducing long-lasting economic burden after breast cancer. Cancer 2019; 125:1929-1940. [PMID: 30839106 PMCID: PMC6508994 DOI: 10.1002/cncr.32012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/27/2018] [Accepted: 01/11/2019] [Indexed: 12/28/2022]
Abstract
Background In the United States, patients who have breast cancer experience significant economic burden compared with those who have other types of cancers. Cancer‐related economic burden is exacerbated by adverse treatment effects. Strategies to resolve the economic burden caused by breast cancer and its adverse treatment effects have stemmed from the perspectives of health care providers, oncology navigators, and other subject‐matter experts. For the current study, patient‐driven recommendations were elicited to reduce economic burden after 1) breast cancer and 2) breast cancer‐related lymphedema, which is a common, persistent adverse effect of breast cancer. Methods Qualitative interviews were conducted with 40 long‐term breast cancer survivors who were residents of Pennsylvania or New Jersey in 2015 and were enrolled in a 6‐month observational study. Purposive sampling ensured equal representation by age, socioeconomic position, and lymphedema diagnosis. Semistructured interviews addressed economic challenges, supports used, and patient recommendations for reducing financial challenges. Interviews were coded, and representative quotes from the patient recommendations were analyzed and reported to illustrate key findings. Results Of 40 interviewees (mean age, 64 years; mean time since diagnosis, 12 years), 27 offered recommendations to reduce the economic burden caused by cancer and its adverse treatment effects. Nine recommendations emerged across 4 major themes: expanding affordable insurance and insurance‐covered items, especially for lymphedema treatment (among the 60% who reported lymphedema); supportive domestic help; financial assistance from diagnosis through treatment; and employment‐preserving policies. Conclusions The current study yielded 9 actionable, patient‐driven recommendations—changes to insurance, supportive services, financial assistance, and protective policies—to reduce breast cancer‐related economic burden. These recommendations should be tested through policy and programmatic interventions. Nine actionable, patient‐driven recommendations are offered for reducing economic burden after breast cancer. Recommendations address changes to insurance, supportive services, financial assistance, and protective policies that can reduce economic burden after cancer.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shadiya L Moss
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Sarah I Rollinson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Livia Frasso Jaramillo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Raheem J Paxton
- Department of Community Medicine and Population Health, University of Alabama, Tuscaloosa, Alabama
| | - Jill T Owczarzak
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Chambers DA, Amir E, Saleh RR, Rodin D, Keating NL, Osterman TJ, Chen JL. The Impact of Big Data Research on Practice, Policy, and Cancer Care. Am Soc Clin Oncol Educ Book 2019; 39:e167-e175. [PMID: 31099675 DOI: 10.1200/edbk_238057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The concept of "big data" research-the aggregation and analysis of biologic, clinical, administrative, and other data sources to drive new advances in biomedical knowledge-has been embraced by the cancer research enterprise. Although much of the conversation has concentrated on the amalgamation of basic biologic data (e.g., genomics, metabolomics, tumor tissue), new opportunities to extend potential contributions of big data to clinical practice and policy abound. This article examines these opportunities through discussion of three major data sources: aggregated clinical trial data, administrative data (including insurance claims data), and data from electronic health records. We will discuss the benefits of data use to answer key oncology practice and policy research questions, along with limitations inherent in these complex data sources. Finally, the article will discuss overarching themes across data types and offer next steps for the research, practice, and policy communities. The use of multiple sources of big data has the promise of improving knowledge and providing more accurate data for clinicians and policy decision makers. In the future, optimization of machine learning may allow for current limitations of big data analyses to be attenuated, thereby resulting in improved patient care and outcomes.
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Affiliation(s)
- David A Chambers
- 1 Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Eitan Amir
- 2 Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ramy R Saleh
- 2 Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Rodin
- 3 Radiation Medicine Program, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Nancy L Keating
- 4 Department of Health Care Policy, Harvard Medical School, Boston, MA
| | | | - James L Chen
- 6 Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
- 7 Department of Biomedical Informatics, The Ohio State University, Columbus, OH
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Hilal T, Betcher JA, Leis JF. Economic Impact of Oral Therapies for Chronic Lymphocytic Leukemia-the Burden of Novelty. Curr Hematol Malig Rep 2018; 13:237-243. [PMID: 29982866 DOI: 10.1007/s11899-018-0461-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Small molecule tyrosine kinase inhibitors (TKIs) and BCL2 inhibitors are oral targeted therapies that have changed the treatment approach to patients with chronic lymphocytic leukemia (CLL). The aim of this review is to summarize the relevant literature on the economic impact of oral novel therapies for the treatment of CLL and discuss the underlying factors and suggested solutions for high drug prices. RECENT FINDINGS The cost of therapy for CLL has increased substantially since the introduction of oral therapies. This increase in cost is caused by multiple factors including cost of drug development, alternate reimbursement patterns, lack of transparency, and lack of free market competition. Oral therapies for CLL have dramatically increased costs for both patients and payers. Some solutions to overcome this include value-based pricing, transparency, and legal action that allow Medicare to negotiate drug prices with manufacturers.
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Affiliation(s)
- Talal Hilal
- Division of Hematology and Medical Oncology, Mayo Clinic, 5881 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | | | - Jose F Leis
- Division of Hematology and Medical Oncology, Mayo Clinic, 5881 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
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Winn AN, Dusetzina SB. More evidence on the limited impact of state oral oncology parity laws. Cancer 2018; 125:335-336. [DOI: 10.1002/cncr.31904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/09/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Aaron N. Winn
- Department of Clinical Sciences, School of Pharmacy Medical College of Wisconsin Milwaukee Wisconsin
- Medical College of Wisconsin Cancer Center Milwaukee Wisconsin
- Center for Advancing Population Sciences Medical College of Wisconsin Milwaukee Wisconsin
| | - Stacie B. Dusetzina
- Department of Health Policy Vanderbilt University School of Medicine Nashville Tennessee
- Vanderbilt‐Ingram Cancer Center Vanderbilt University Medical Center Nashville Tennessee
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Chin AL, Bentley JP, Pollom EL. The impact of state parity laws on copayments for and adherence to oral endocrine therapy for breast cancer. Cancer 2018; 125:374-381. [PMID: 30566762 DOI: 10.1002/cncr.31910] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Adherence to endocrine therapy for breast cancer is often inadequate, in part because of out-of-pocket costs for medication. Numerous states have enacted parity laws to limit patient cost-sharing for oral anticancer drugs. The objective of this study was to estimate the impact of these laws on patient copayments for and adherence to oral endocrine therapy for breast cancer. METHODS Administrative health insurance claims data from 2007 to 2014 derived from a US health care database were used to identify female patients aged 18 to 64 years with invasive cancer or ductal carcinoma in situ of the breast who initiated endocrine therapy and were enrolled in fully insured health plans in states that either enacted parity legislation between 2008 and 2013 or had not yet enacted such legislation by 2015. Differences-in-differences analysis was used to compare copayments for and adherence to endocrine therapy during the 1-year period before and after each year of legislation enactment. RESULTS In total, 6900 individuals who received 7778 unique drug therapy courses were identified. Parity legislation was associated with significant decreases in the 25th percentile of copayments for anastrozole of $4.39 (95% confidence interval [CI], -$4.52 to -$4.26; P < .001) and for exemestane of $3.08 (95% CI, -$4.80 to -$1.35; P < .001). The median copayment for exemestane decreased by $10.25 (95% CI, -$12.61 to -$7.89; P < .001). A higher median monthly copayment was significantly associated with a greater risk of medication nonadherence (adjusted risk ratio, 1.006 per dollar increase; P < .001). CONCLUSIONS Parity laws had a modest effect on lowering the cost of anastrozole and exemestane, but more focused efforts to limit out-of-pocket costs for endocrine therapy may have a greater impact on medication adherence.
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Affiliation(s)
- Alexander L Chin
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Jason P Bentley
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
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Yabroff KR, Zhao J, Zheng Z, Rai A, Han X. Medical Financial Hardship among Cancer Survivors in the United States: What Do We Know? What Do We Need to Know? Cancer Epidemiol Biomarkers Prev 2018; 27:1389-1397. [DOI: 10.1158/1055-9965.epi-18-0617] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/19/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
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Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations. PHARMACY 2018. [PMID: 29518017 PMCID: PMC5874562 DOI: 10.3390/pharmacy6010023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.
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