Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Cancer Prevention and Population Sciences Division, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
Am J Obstet Gynecol. 2021 Jul;225(1):68.e1-68.e11. doi: 10.1016/j.ajog.2021.01.029. Epub 2021 Feb 4.
More patients with ovarian cancer are being treated with poly(adenosine diphosphate-ribose) polymerase inhibitors because regulatory agencies have granted these drugs new approvals for a variety of treatment indications. However, poly(adenosine diphosphate-ribose) polymerase inhibitors are expensive. When administered as a maintenance therapy, these drugs may be administered for months or years. How much of this cost patients experience as out-of-pocket spending is unknown.
This study aimed to estimate the out-of-pocket spending that patients experience during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment and to characterize which healthcare services account for that spending.
A retrospective cohort study was performed with a sample of patients with ovarian cancer treated between 2014 and 2017 with olaparib, niraparib, or rucaparib. Patients were identified using MarketScan, a health insurance claims database. All insurance claims during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment were collected. The primary outcome variable was the patients' out-of-pocket spending (copayment, coinsurance, and deductibles) during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment for the medication itself. Other outcomes of interest included out-of-pocket spending for other healthcare services, the types and frequency of other healthcare services used, health plan spending, the estimated proportion of patients' household income used each month for healthcare, and patients' out-of-pocket spending immediately before poly(adenosine diphosphate-ribose) polymerase inhibitor treatment.
We identified 503 patients with ovarian cancer with a median age of 55 years (interquartile range, 50-62 years); 83% of those had out-of-pocket spendings during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment. The median treatment duration was 124 days (interquartile range, 66-240 days). The mean out-of-pocket spending for poly(adenosine diphosphate-ribose) polymerase inhibitors was $305 (standard deviation, $2275) per month. On average, this accounted for 44.8% (standard deviation, 34.8%) of the patients' overall monthly out-of-pocket spending. The mean out-of-pocket spending for other healthcare services was $165 (standard deviation, $769) per month. Health plans spent, on average, $12,661 (standard deviation, $15,668) per month for poly(adenosine diphosphate-ribose) polymerase inhibitors and $7108 (standard deviation, $15,254) per month for all other healthcare services. The cost sharing for office visits, laboratory tests, and imaging studies represented the majority of non-poly(adenosine diphosphate-ribose) polymerase inhibitor treatment out-of-pocket spending. The average amount patients paid for all healthcare services per month during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment was $470 (standard deviation, $2407), which was estimated to be 8.7% of the patients' monthly household income. The mean out-of-pocket spending in the 12 months before poly(adenosine diphosphate-ribose) polymerase inhibitor treatment was $3110 (standard deviation, $6987).
Patients can face high out-of-pocket costs for poly(adenosine diphosphate-ribose) polymerase inhibitors, although the sum of cost sharing for other healthcare services used during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment is often higher. The spending on healthcare costs consumes a large proportion of these patients' household income. Patients with ovarian cancer experience high out-of-pocket costs for healthcare, both before and during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment.
由于监管机构对各种治疗适应症批准了这些药物的新批准，越来越多的卵巢癌患者正在接受聚（二磷酸腺苷核糖）聚合酶抑制剂的治疗。然而，聚（二磷酸腺苷核糖）聚合酶抑制剂价格昂贵。当作为维持治疗给予时，这些药物可能会连续数月或数年给予。患者需要自付多少费用尚不清楚。
本研究旨在估算患者在接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗期间的自付费用，并描述哪些医疗服务构成了这些费用。
这是一项使用市场扫描（医疗保险索赔数据库）的卵巢癌患者的回顾性队列研究。确定了在 2014 年至 2017 年期间接受奥拉帕利、尼拉帕利或鲁卡帕利治疗的患者。收集了患者在接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗期间的所有医疗保险索赔。主要结局变量是患者在接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗期间用于药物本身的自付费用（共付额、自付额和免赔额）。其他感兴趣的结果包括其他医疗服务的自付费用、使用其他医疗服务的类型和频率、健康计划支出、每月用于医疗的患者家庭收入的估计比例以及接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗前患者的自付费用。
我们确定了 503 名患有卵巢癌的患者，中位年龄为 55 岁（四分位间距，50-62 岁）；83%的患者在接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗时有自付费用。中位治疗持续时间为 124 天（四分位间距，66-240 天）。聚（二磷酸腺苷核糖）聚合酶抑制剂的平均自付费用为每月 305 美元（标准差，2275 美元）。平均而言，这占患者每月总自付费用的 44.8%（标准差，34.8%）。其他医疗服务的平均自付费用为每月 165 美元（标准差，769 美元）。健康计划每月平均支出 12661 美元（标准差，15668 美元）用于聚（二磷酸腺苷核糖）聚合酶抑制剂，每月支出 7108 美元（标准差，15254 美元）用于所有其他医疗服务。门诊、实验室检查和影像学研究的费用分担代表了非聚（二磷酸腺苷核糖）聚合酶抑制剂治疗自付费用的大部分。患者在接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗期间每月支付的所有医疗服务的平均费用为 470 美元（标准差，2407 美元），估计为患者每月家庭收入的 8.7%。在接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗前 12 个月的平均自付费用为 3110 美元（标准差，6987 美元）。
尽管患者在接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗期间使用的其他医疗服务的费用分担总和通常更高，但患者可能面临高昂的聚（二磷酸腺苷核糖）聚合酶抑制剂自付费用。这些患者的家庭收入中有很大一部分用于医疗保健支出。卵巢癌患者在接受聚（二磷酸腺苷核糖）聚合酶抑制剂治疗之前和之后都要承担高昂的医疗保健自付费用。
