Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
J Natl Cancer Inst. 2022 Jun 13;114(6):871-877. doi: 10.1093/jnci/djac026.
Adherence to oral cancer drugs is suboptimal. The Oncology Care Model (OCM) offers oncology practices financial incentives to improve the value of cancer care. We assessed the impact of OCM on adherence to oral cancer therapy for chronic myelogenous leukemia (CML), prostate cancer, and breast cancer.
Using 2014-2019 Medicare data, we studied chemotherapy episodes for Medicare fee-for-service beneficiaries prescribed tyrosine kinase inhibitors (TKIs) for CML, antiandrogens (ie, enzalutamide, abiraterone) for prostate cancer, or hormonal therapies for breast cancer in OCM-participating and propensity-matched comparison practices. We measured adherence as the proportion of days covered and used difference-in-difference (DID) models to detect changes in adherence over time, adjusting for patient, practice, and market-level characteristics.
There was no overall impact of OCM on improved adherence to TKIs for CML (DID = -0.3%, 90% confidence interval [CI] = -1.2% to 0.6%), antiandrogens for prostate cancer (DID = 0.4%, 90% CI = -0.3% to 1.2%), or hormonal therapy for breast cancer (DID = 0.0%, 90% CI = -0.2% to 0.2%). Among episodes for Black beneficiaries in OCM practices, for whom adherence was lower than for White beneficiaries at baseline, we observed small improvements in adherence to high cost TKIs (DID = 3.0%, 90% CI = 0.2% to 5.8%) and antiandrogens (DID = 2.2%, 90% CI = 0.2% to 4.3%).
OCM did not impact adherence to oral cancer therapies for Medicare beneficiaries with CML, prostate cancer, or breast cancer overall but modestly improved adherence to high-cost TKIs and antiandrogens for Black beneficiaries, who had somewhat lower adherence than White beneficiaries at baseline. Patient navigation and financial counseling are potential mechanisms for improvement among Black beneficiaries.
口腔癌药物的依从性并不理想。肿瘤护理模式（OCM）为肿瘤学实践提供了经济激励，以提高癌症护理的价值。我们评估了 OCM 对慢性髓细胞白血病（CML）、前列腺癌和乳腺癌患者口服癌症治疗依从性的影响。
我们使用 2014-2019 年医疗保险数据，研究了接受医疗保险服务的患者中接受酪氨酸激酶抑制剂（TKI）治疗 CML、抗雄激素（即恩扎鲁胺、阿比特龙）治疗前列腺癌或激素治疗乳腺癌的化疗病例，这些患者在 OCM 参与和倾向匹配比较实践中。我们将药物依从性定义为覆盖天数的比例，并使用差异（DID）模型来检测随时间推移的药物依从性变化，同时调整患者、实践和市场水平的特征。
OCM 对改善 CML 的 TKI （DID = -0.3%，90%置信区间 [CI] = -1.2%至 0.6%）、前列腺癌的抗雄激素（DID = 0.4%，90% CI = -0.3%至 1.2%）或乳腺癌的激素治疗的依从性没有总体影响（DID = 0.0%，90% CI = -0.2%至 0.2%）。在 OCM 实践中接受治疗的黑人受益人的治疗中，他们的依从性在基线时低于白人受益人，我们观察到他们对高成本 TKI（DID = 3.0%，90% CI = 0.2%至 5.8%）和抗雄激素（DID = 2.2%，90% CI = 0.2%至 4.3%）的依从性有微小改善。
OCM 并没有影响医疗保险受益人的 CML、前列腺癌或乳腺癌患者的口服癌症治疗的依从性，但对黑人受益人的高成本 TKI 和抗雄激素的依从性略有改善，他们在基线时的依从性略低于白人受益人。患者导航和财务咨询是提高黑人受益人的潜在机制。
