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New Study Finds That 10% of Cancer Patients Abandoned Oral Anti-Cancer Drugs
Date:5/18/2011

WASHINGTON, May 18, 2011 /PRNewswire/ -- Ten percent of cancer patients failed to fill their initial prescriptions for oral anti-cancer drugs, according to a new study published jointly today in the Journal of Oncology Practice (JOP) and American Journal of Managed Care (AJMC). The study was based on an analysis conducted by Avalere Health LLC using pharmacy transaction data over a two-year period from 2007 to 2009. This study has also been accepted for presentation at the American Society of Clinical Oncology annual meeting on June 6th (abstract number 82120).

The study, "Patient and Plan Characteristics Affecting Abandonment of Oral Oncolytic Prescriptions," finds that patients were primarily abandoning their anti-cancer drugs due to two key factors: high cost-sharing and higher prescription activity. For example, claims with cost-sharing over $500 were four times more likely to be abandoned than claims with cost-sharing of $100 or less. Across the sample of prescription claims studied, Medicare coverage and lower income were also related to higher rates of abandonment when each were compared individually.

The study shows that while anti-cancer medicines offer benefits to patients, access to them is difficult due to high rates of cost-sharing. While 73 percent of newly initiated oncolytic patients had a cost-sharing amount of $100 of less, 16 percent required an out-of-pocket cost of greater than $500. The study found that the abandonment rate increased with cost-sharing amounts. Claims with cost-sharing above $500 had the highest abandonment rate – 25 percent – as compared with an abandonment rate of six percent for claims with cost-sharing of $100 or less.

"Our study shows that many cancer patients are abandoning the medicine they need," said Lauren Barnes, vice president, Avalere Health. "With 45.5 percent of Medicare patients in our sample facing cost-sharing greater than $500 for their first anti-cancer drug, this is a Medicare quality issue of the first order."

The study was authored by experts from Avalere Health, including Michael Johnsrud, PhD, who leads the Health Economics and Outcomes Research group at Avalere Health, and oncologist Lee Schwartzberg, MD, medical director of The West Clinic in Memphis, Tenn.

Until recently, drug therapy for patients with cancer consisted of intravenous (IV) infused treatment. Anti-cancer medications that can be administered orally are a relatively new addition to cancer patients and provide benefits to patients. Such oral anti-cancer medications are reported to account for approximately 25 to 35 percent of the current oncology pipeline.

"Cost-sharing clearly has an impact on whether a patient initiates his or her oral anti-cancer medicine, with the abandonment rate rising as the cost-sharing increases," said Johnsrud, a senior vice president at Avalere Health. "Importantly, claims for cost-sharing over $500 have more than four times higher an abandonment rate than claims of cost-sharing with less than $100. This demonstrates that patients are confronted with potential barriers in accessing anti-cancer medications."

The number of concurrent prescriptions also had an impact on abandonment of an oncolytic. Patients with more than five claims for non-cancer medicines in the previous month had an abandonment rate of 12 percent, as compared to nine percent for patients with no claims in the previous month.

Finally, lower income and patients covered by Medicare also had higher rates of abandoning their anti-cancer medications. Patients with incomes of less than $40,000 per year had an abandonment rate of 11 percent, decreasing to 10 percent for incomes between $40,000 and $75,000 and nine percent for incomes above $75,000. Abandonment rates for Medicare claims were 16 percent, versus 9 percent for those with commercial insurance.

"The bottom line is that patients should have access to the most clinically appropriate care for their condition," said Schwartzberg. "We should not be creating obstacles to care for those who need it the most."

The authors used a nationally representative pharmacy claims database and identified 10,508 patients with Medicare and commercial insurance for whom oral anti-cancer therapy was initiated between 2007 and 2009. They 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. The authors used bivariate and multivariate logistic regression analyses including patient demographics, plan type, drug type, cost-sharing and concurrent prescription activity.

In addition to Johnsrud and Schwartzberg, the study was authored by Sonya Blesser Streeter, MPP, MPH and Nadia Husain, ScM of Avalere. It was funded by the Community Oncology Alliance, in partnership with Celgene Corporation, Genentech, Millennium Pharmaceuticals, Novartis Pharmaceuticals and Pfizer, Inc.

Avalere Health is an advisory services company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington DC, the firm delivers research, analysis, insight, and strategy for leaders in healthcare business and policy. Avalere's experts span 140 staff drawn from the federal government (e.g., CMS, OMB, CBO, and the Congress), Fortune 500 healthcare companies, top consultancies, and nonprofits. The firm offers deep substance in areas ranging from healthcare coverage and financing to the changing role of evidence in healthcare decision-making. Its focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications, and interactive programs, Avalere also translates real-time healthcare developments into actionable information.


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