Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Ann Arbor VA Center for Clinical Management Research, VA Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
Cancer. 2020 Dec 1;126(23):5050-5059. doi: 10.1002/cncr.33176. Epub 2020 Sep 14.
Abiraterone and enzalutamide are high-cost oral therapies that increasingly are used to treat patients with advanced prostate cancer; these agents carry the potential for significant financial consequences to patients. In the current study, the authors investigated coping and material measures of the financial hardship of these therapies among patients with Medicare Part D coverage.
The authors performed a retrospective cohort study on a 20% sample of Medicare Part D enrollees who underwent treatment with abiraterone or enzalutamide between July 2013 and June 2015. The authors described the variability in adherence rates and out-of-pocket payments among hospital referral regions in the first 6 months of therapy and determined whether adherence and out-of-pocket payments were associated with patient factors and the socioeconomic characteristics of where a patient was treated.
There were 4153 patients who filled abiraterone or enzalutamide prescriptions through Medicare Part D in 228 hospital referral regions. The mean adherence rate was 75%. The median monthly out-of-pocket payment for abiraterone and enzalutamide was $706 (range, $0-$3505). After multilevel, multivariable adjustment for patient and regional factors, adherence was found to be lower in patients who were older (69% for patients aged ≥85 years vs 76% for patients aged <70 years; P < .01) and in those with low-income subsidies (69% in those with a subsidy vs 76% in those without a subsidy; P < .01). Both Hispanic ethnicity and living in a hospital referral region with a higher percentage of Hispanic beneficiaries were found to be independently associated with higher out-of-pocket payments for abiraterone and enzalutamide.
There were substantial variations in the adherence rate and out-of-pocket payments among Medicare Part D beneficiaries who were prescribed abiraterone and enzalutamide. Sociodemographic patient and regional factors were found to be associated with both adherence and out-of-pocket payments.
阿比特龙和恩扎鲁胺是两种高成本的口服疗法，越来越多地用于治疗晚期前列腺癌患者；这些药物可能会给患者带来重大的经济后果。在目前的研究中，作者研究了医疗保险 D 部分覆盖的患者使用这些药物治疗时的财务困境的应对和物质措施。
作者对 2013 年 7 月至 2015 年 6 月期间接受阿比特龙或恩扎鲁胺治疗的医疗保险 D 部分 20%的参保者进行了回顾性队列研究。作者描述了治疗的前 6 个月内，各医院转诊区的药物依从率和自付费用的变化情况，并确定了药物依从率和自付费用是否与患者因素以及患者治疗地点的社会经济特征有关。
共有 4153 名患者在 228 个医院转诊区通过医疗保险 D 部分开出了阿比特龙或恩扎鲁胺的处方。平均药物依从率为 75%。阿比特龙和恩扎鲁胺的月均自付费用中位数为 706 美元（范围为 0 美元至 3505 美元）。在对患者和区域因素进行多层次、多变量调整后，发现年龄较大的患者（≥85 岁的患者为 69%，<70 岁的患者为 76%；P<0.01）和低收入补贴患者（有补贴的患者为 69%，无补贴的患者为 76%；P<0.01）的药物依从性较低。研究还发现，西班牙裔种族和居住在西班牙裔受益人口比例较高的医院转诊区与阿比特龙和恩扎鲁胺的自付费用较高独立相关。
接受阿比特龙和恩扎鲁胺治疗的医疗保险 D 部分参保者的药物依从率和自付费用存在很大差异。社会人口学患者和区域因素与药物依从率和自付费用均有关。
