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.

22 Reads
    • "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 ) ] ] ] – ] ] ] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Positive associations between medication adherence and beneficial outcomes primarily come from studying filling/consumption behaviors after therapy initiation. Few studies have focused on what happens before initiation, the point from prescribing to dispensing of an initial prescription. Our objective was to provide guidance and encourage high-quality research on the relationship between beneficial outcomes and initial medication adherence (IMA), the rate initially prescribed medication is dispensed. Using generic adherence terms, an international research panel identified IMA publications from 1966 to 2014. Their data sources were classified as to whether the primary source reflected the perspective of a prescriber, patient, or pharmacist or a combined perspective. Terminology and methodological differences were documented among core (essential elements of presented and unpresented prescribing events and claimed and unclaimed dispensing events regardless of setting), supplemental (refined for accuracy), and contextual (setting-specific) design parameters. Recommendations were made to encourage and guide future research. The 45 IMA studies identified used multiple terms for IMA and operationalized measurements differently. Primary data sources reflecting a prescriber's and pharmacist's perspective potentially misclassified core parameters more often with shorter/nonexistent pre- and postperiods (1-14 days) than did a combined perspective. Only a few studies addressed supplemental issues, and minimal contextual information was provided. General recommendations are to use IMA as the standard nomenclature, rigorously identify all data sources, and delineate all design parameters. Specific methodological recommendations include providing convincing evidence that initial prescribing and dispensing events are identified, supplemental parameters incorporating perspective and substitution biases are addressed, and contextual parameters are included. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
    Value in Health 05/2015; 18(5). DOI:10.1016/j.jval.2015.02.015 · 3.28 Impact Factor
  • Source
    • "Adherence, which is the extent to which a person's behavior taking medication corresponds with agreed recommendations from the healthcare provider , is a major and sometimes unrecognized source of variability in the clinical setting [31]. However, adherence has been poorly explored in solid tumors, mainly in the setting of chronic administration [32] [33], despite the increased prescription of oral target therapies. To the best of our knowledge, a precise recording of the last drug intake before PET scanning (i.e., the date and if possible, precise hour) is neither routinely done in PET units nor recommended by the European Association of Nuclear Medicine (EANM) [34] or Society of Nuclear Medicine (SNM) [35] guidelines for tumor imaging. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Targeting the phosphoinositide 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) pathway is a potential means of overcoming chemoresistance in ovarian cancer. We investigated the capability of (18)F-fluororodeoxyglucose ((18)F-FDG) small-animal positron emission tomography (SA-PET) to predict the effects of a dual PI3K/mTOR inhibitor (BEZ-235) in a cisplatin-resistant ovarian cancer model. In a first experiment, nude rats bearing subcutaneous SKOV3 tumors received BEZ-235 for 3 days given alone or after paclitaxel and were compared to controls (either untreated or that were given the excipients of paclitaxel and BEZ-235). SA-PET was performed at baseline, on day 3, and day 7. In a second experiment aiming at further exploring the kinetics of (18)F-FDG tumor uptake during the first 48 hours following drug cessation, untreated controls were compared to rats receiving BEZ-235, which were imaged at baseline, on day 3, on day 4, and on day 5. SA-PET results were compared to cell proliferation assessment (Ki-67), PI3K/mTOR downstream target expression studies (pAKT and phospho-eukaryotic translation initiation factor 4E-binding protein 1), and apoptosis evaluation (cleaved caspase-3). In the first experiment, BEZ-235, compared to untreated controls, induced a marked decrease in (18)F-FDG uptake on day 3, which was correlated to a significant decrease in cell proliferation and to a significant PI3K/mTOR pathway inhibition. No tumor necrosis or apoptosis occurred. Four days following treatment cessation, tumor recovery (in terms of PI3K/mTOR inhibition and cell proliferation) occurred and was identified by (18)F-FDG SA-PET. Paclitaxel plus BEZ-235 showed results similar to BEZ-235 alone. In the second experiment, PI3K/mTOR pathways exhibited partial recovery as early as 24 hours following treatment cessation, but both (18)F-FDG SA-PET and cell proliferation remained unchanged. (18)F-FDG SA-PET is a surrogate marker of target inhibition during treatment with BEZ-235 and predicts tumor recovery 4 days after drug withdrawal, but not during the first 48 hours following drug cessation, when a lag between PI3K/mTOR pathway recovery and metabolic recovery is observed. (18)F-FDG SA-PET could be used for therapy monitoring of PI3K/mTOR inhibitors, but our results also raise questions regarding the potential impact of the delay between PET imaging and the last drug intake on the accuracy of FDG imaging.
    Translational oncology 10/2013; 6(5):586-95. DOI:10.1593/tlo.13100 · 2.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cancer costs are increasing at an unprecedented rate. Key cost drivers include chemotherapy, hospital admissions/emergency room visits, and aggressive end-of-life care. We sought to evaluate these costs in a commercial payer population in collaboration with consultants from Milliman. We used a retrospective analysis of Medstat 2007 to evaluate chemotherapy costs and use. Included patients had a cancer diagnosis; received chemotherapy during the evaluation period; had at least 1 day of coverage between January 1 and December 31, 2007 (medical and prescription coverage); was younger than age 70, and had active employment or was the spouse of an active employee. Costs are allowed amounts and are trended until 2009. Admission rates and emergency room visits are reported. Hospice use and chemotherapy during the last 14 and 30 days of life were also evaluated. In this commercial population of 14 million patients, 0.68% had claims for a cancer diagnosis; approximately 22% of those received chemotherapy during the study time period. Patients with cancer receiving chemotherapy averaged $111,000 per year in total medical and pharmacy costs. The average hospitalization rate for any reason was 1 admission/yr. Approximately 40% (or 0.4 admits/year) were identified as being chemotherapy related. Of the 3.5% of patients who died in the hospital, 51% received chemotherapy within 30 days of death. Understanding the costs of cancer care offers opportunities to formulate a strategic plan to control cancer costs and maintain quality care. Comprehensive cancer solutions to address the full spectrum of care will facilitate improved quality and patient outcomes.
    Journal of Oncology Practice 09/2011; 7(5):301-6. DOI:10.1200/JOP.2011.000394
Show more


22 Reads
Available from