Patient and Plan Characteristics Affecting Abandonment of Oral Oncolytic Prescriptions

Avalere Health, Health Economics and Outcomes Services, 1350 Connecticut Ave NW, Washington, DC 20036, USA.
The American journal of managed care (Impact Factor: 2.26). 05/2011; 17 Suppl 5 Developing(3S):SP38-44. DOI: 10.1200/JOP.2011.000316
Source: PubMed


To calculate the abandonment rate of oral oncolytic medications and identify factors that may affect likelihood of abandonment.
Cross-sectional cohort study using administrative claims data.
We analyzed a nationally representative pharmacy claims database and identified 10,508 patients with Medicare and commercial insurance for whom oral oncolytic therapy was initiated between 2007 and 2009. We calculated the abandonment rate for the initial claim, in which abandonment was defined as reversal of an adjudicated pharmacy claim without a subsequent paid claim for any oncolytic (oral or intravenous) within the ensuing 90 days. We assessed likelihood of abandonment using bivariate and multivariate logistic regression analyses including patient demographics, plan type, drug type, cost sharing, and concurrent prescription activity.
The abandonment rate of newly initiated oral oncolytics was 10.0%. Unadjusted bivariate analyses found that high cost sharing, increased prescription activity, lower income, and Medicare coverage were associated with a higher abandonment rate (P <.05). In the logistic regression model, claims with cost sharing greater than $500 were 4 times more likely to be abandoned than claims with cost sharing of $100 or less (odds ratio [OR], 4.46; P <.001). Patients with 5 or more prescription claims processed within in the previous month had 50% higher likelihood of abandonment than patients with no other prescription activity (OR, 1.50; P <.001).
Abandonment of newly prescribed oral oncolytic therapy is not uncommon, and the likelihood increases for patients enrolled in plans with pharmacy benefit designs that require high cost sharing. Increased concurrent prescription activity was also associated with a higher abandonment rate. These factors should be taken into account when considering likely adherence to cancer therapy.

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    • "Wroth and Pathman (2006) United States 3,926 Patients Nov 2002 to Jul 2003 NA 0–365 Pharmacist [27] Gleason et al. (2009) United States 10,104 Patients Jul 2006 to Dec 2008 90 90 [24] Fincham and Wertheimer (1986) United States 32 Patients 4-mo period 0 14 [30] McCaffrey et al. (1995) United States 522 Pharmacies 8 wk 0 7 [29] McCaffrey et al. (1998) United States 128 Pharmacies 12 wk 0 30 [53] Menckeberg et al. (2008) The Netherlands 667 Patients 6 y 730 180 [54] Skutnik and Katsanis (1997) Quebec 254 Prescriptions 4-wk period 0 14 [37] Streeter et al. (2011) United States 10,508 Patients May 2007 to Jun 2009 120 90 Combined [20] Berger et al. (2009) United States 2,023 Patients Jan 2002 to Dec 2006 180 30 [21] Cheetham et al. (2013) United States 19,826 Patients Dec 2009 to May 2010 365 90 [22] Derose et al. (2013) United States 2,606 Patients Apr 2010 to Jun 2010 365 7–60 [48] Ekedahl and Mansson (2004) Sweden 91,704 Prescriptions Mar 2000 to Sep 2000 0 120–210 [25] Fischer et al. (2010) United States 75,589 Patients Apr 2004 to Mar 2005 180–365 0–365 [60] Fischer et al. (2011) United States 280,081 Patients Jul 2007 to Dec 2009 180 180 continued on next page V A L U E I N H E A L T H ] ( 2 0 1 5 ) ] ] ] – ] ] ] "
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