Avalere Health, Health Economics and Outcomes Services, 1350 Connecticut Ave NW, Washington, DC 20036, USA.
Am J Manag Care. 2011 May;17 Suppl 5 Developing:SP38-44.
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.
计算口服肿瘤药物的停药率，并确定可能影响停药可能性的因素。
使用行政索赔数据的横断面队列研究。
我们分析了一个全国代表性的药房索赔数据库，确定了 2007 年至 2009 年期间有医疗保险和商业保险的 10508 名开始口服肿瘤治疗的患者。我们计算了初始索赔的停药率，其中停药定义为在接下来的 90 天内，对经裁定的药房索赔进行逆转，而没有随后为任何肿瘤药物（口服或静脉内）支付任何费用。我们使用包括患者人口统计学、计划类型、药物类型、费用分担和同时处方活动在内的双变量和多变量逻辑回归分析评估了停药的可能性。
新开始的口服肿瘤药物的停药率为 10.0%。未经调整的双变量分析发现，高费用分担、增加的处方活动、较低的收入和医疗保险覆盖与较高的停药率相关（P <.05）。在逻辑回归模型中，费用分担超过 500 美元的索赔比费用分担为 100 美元或更少的索赔被放弃的可能性高 4 倍（优势比[OR]，4.46；P <.001）。在过去一个月内处理了 5 次或更多处方的患者比没有其他处方活动的患者停药的可能性高 50%（OR，1.50；P <.001）。
新处方的口服肿瘤治疗药物的停药并不罕见，对于参加需要高费用分担的药房福利设计计划的患者，这种可能性会增加。同时处方活动的增加也与较高的停药率相关。在考虑癌症治疗的可能依从性时，应考虑这些因素。
