老年人自付费用与口腔癌药物停药。

Out-of-pocket costs and oral cancer medication discontinuation in the elderly.

机构信息

Virginia Commonwealth University, 410 N. 12th St., P.O. Box 980533, Richmond, VA 23298.

出版信息

J Manag Care Spec Pharm. 2014 Jul;20(7):669-75. doi: 10.18553/jmcp.2014.20.7.669.

DOI:10.18553/jmcp.2014.20.7.669

PMID:24967520

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10437384/

Abstract

BACKGROUND

Cancer is a major cause of mortality and a major contributor to health care costs in the United States. An increasing number of cancer patients are treated with oral cancer therapy. Older patients are more likely to have cancer and to be at risk for adherence problems with oral cancer drugs. As a result of substantial cost sharing required for oral cancer drugs and the possibility of early entry into the Medicare Part D coverage gap, high out-of-pocket (OOP) drug costs could put elderly beneficiaries at great risk for delaying or discontinuing their cancer therapies.

OBJECTIVES

To (a) determine the OOP costs of oral cancer treatment and the numbers of patients that delay or discontinue oral cancer therapy and (b) examine the relationship between OOP costs and medication discontinuation or delay among older Medicare beneficiaries.

METHODS

A cross-sectional study was conducted using a 5% sample of Medicare beneficiaries who filled a prescription for imatinib, erlotinib, anastrozole, letrozole, or thalidomide during 2008. Patients included in the analysis sample did not receive drug subsidies, were aged 65 years or older, and were enrolled in Medicare Part D for all 12 months of 2008. Logistic regression was used to determine the association between OOP costs and medication discontinuation or delay.

RESULTS

Mean OOP costs per day were $2.96 for anastrozole, $3.10 for letrozole, $22.90 for imatinib, $28.35 for erlotinib, and $37.47 for thalidomide. The percentages of patients who discontinued or delayed oral cancer therapy were 58% for anastrozole, 64% for letrozole, 35% for imatinib, 61% for erlotinib, and 70% for thalidomide. For each $10 increase in OOP spending per month, the likelihood of discontinuation or delay increased 13%, 14%, and 20% for imatinib, erlotinib, and thalidomide users, respectively, but decreased 26% for anastrozole and letrozole users.

CONCLUSION

Beneficiaries with higher OOP costs for the more expensive oral cancer drugs were more likely to discontinue or delay drug therapy.

摘要

背景

癌症是美国死亡的主要原因之一，也是医疗保健费用的主要贡献者。越来越多的癌症患者接受口服癌症治疗。老年患者更有可能患有癌症，并面临口服癌症药物依从性问题的风险。由于口服癌症药物需要大量分担成本，并且有可能提前进入医疗保险 D 部分覆盖缺口，因此高额自付（OOP）药物费用可能使老年受益人面临极大的风险，导致他们延迟或停止癌症治疗。

目的

（a）确定口服癌症治疗的 OOP 成本以及延迟或停止口服癌症治疗的患者数量；（b）研究 OOP 成本与老年医疗保险受益人药物停药或延迟之间的关系。

方法

使用 2008 年填写伊马替尼、厄洛替尼、阿那曲唑、来曲唑或沙利度胺处方的医疗保险受益人的 5%样本进行横断面研究。分析样本中的患者未获得药物补贴，年龄在 65 岁或以上，并且在 2008 年的 12 个月中均参加了医疗保险 D 部分。使用逻辑回归来确定 OOP 成本与药物停药或延迟之间的关联。

结果

阿那曲唑、来曲唑、伊马替尼、厄洛替尼和沙利度胺的每日 OOP 平均成本分别为 2.96 美元、3.10 美元、22.90 美元、28.35 美元和 37.47 美元。停止或延迟口服癌症治疗的患者比例分别为阿那曲唑 58%、来曲唑 64%、伊马替尼 35%、厄洛替尼 61%和沙利度胺 70%。对于每个月 OOP 支出增加 10 美元，伊马替尼、厄洛替尼和沙利度胺使用者停止或延迟药物治疗的可能性分别增加 13%、14%和 20%，而阿那曲唑和来曲唑使用者则减少 26%。