Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.
Urol Pract. 2024 Nov;11(6):931-938. doi: 10.1097/UPJ.0000000000000655. Epub 2024 Jun 26.
The use of expensive oral targeted agents for advanced prostate cancer can be influenced by those who stand to gain from their use. The 340B drug pricing program allows eligible hospitals to purchase medications at steep discounts, generating millions of dollars in savings. The extent to which hospitals engage in higher-risk prescribing due to program incentives is unclear.
Medicare claims were used to perform a retrospective study of men with advanced prostate cancer. The primary outcome was targeted therapy use in men with high noncancer mortality risk. Secondary outcomes included androgen biosynthesis inhibitor use in men with cardiovascular history, androgen receptor inhibitor use in men with neurocognitive history, and therapy within 14 days of death. Proportional hazards models were used to assess time-to-event outcomes, while logistic regression was used for binary outcomes.
In men with high noncancer mortality risk, targeted therapy use did not differ at 340B participating compared to nonparticipating hospitals (hazard ratio [HR] 1.1, 95% CI 0.67-1.5). There was no difference in androgen biosynthesis inhibitor use in men with a prior cardiac event (HR 0.96, 95% CI 0.70-1.3) or androgen receptor inhibitor use in men with a prior neurocognitive event (HR 1.5, 95% CI 0.65-3.4) in those treated at 340B participating compared to nonparticipating hospitals. Therapy use in the last 14 days of life did not vary by 340B participation (odds ratio 1.3, 95% CI 0.86-1.9).
In men with advanced prostate cancer, high-risk prescribing and futility measures did not vary by participation in the 340B drug pricing program.
昂贵的口服靶向药物在晚期前列腺癌中的应用可能会受到利益相关者的影响。340B 药品定价计划允许符合条件的医院以大幅折扣购买药物，从而节省了数百万美元。由于该计划的激励措施，医院在多大程度上进行高风险处方尚不清楚。
使用医疗保险索赔数据对患有晚期前列腺癌的男性进行回顾性研究。主要结局是评估高非癌症死亡率风险男性中靶向治疗的使用情况。次要结局包括有心血管病史男性中雄激素生物合成抑制剂的使用、有神经认知病史男性中雄激素受体抑制剂的使用以及死亡后 14 天内的治疗。使用比例风险模型评估时间事件结局，使用逻辑回归评估二项结局。
在高非癌症死亡率风险男性中，340B 参与医院与非参与医院的靶向治疗使用情况无差异（风险比 [HR] 1.1，95%置信区间 [CI] 0.67-1.5）。在有先前心脏事件的男性中，雄激素生物合成抑制剂的使用无差异（HR 0.96，95%CI 0.70-1.3），在有先前神经认知事件的男性中，雄激素受体抑制剂的使用也无差异（HR 1.5，95%CI 0.65-3.4），这些患者在 340B 参与医院和非参与医院接受治疗。在生命的最后 14 天内使用的治疗方法不因 340B 参与而变化（比值比 1.3，95%CI 0.86-1.9）。
在患有晚期前列腺癌的男性中，高风险处方和无效措施的使用情况不因参与 340B 药品定价计划而有所不同。
