Medication adherence among prostate cancer patients using advanced oral therapies.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 44-44
Author(s):  
Dominic Pilon ◽  
Joyce Lamori ◽  
Carmine Rossi ◽  
Isabelle Ghelerter ◽  
Xuehua Ke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Resource Utilization ◽  
Index Date ◽  
Standard Of Care ◽  
Abiraterone Acetate ◽  
Healthcare Resource Utilization ◽  
Clinical Activity ◽  
Outpatient Services ◽  
Real World Data ◽  
Medicare Coverage

44 Background: Prostate cancer (PC) is associated with a high clinical and economic burden. Advanced oral (AO) therapies have become the standard of care for patients with advanced PC, but real-world data on treatment patterns and their impact on healthcare resource utilization (HRU) are lacking. This study aims to describe treatment adherence, factors associated with adherence, and its impact on HRU in patients with PC initiated on AOs. Methods: Adults with a PC diagnosis initiated on apalutamide, enzalutamide, or abiraterone acetate were identified using Symphony Health Solutions Patient Transactional Databases (10/01/2014-09/30/2019). Patients were included if they had ≥6 months of continuous clinical activity before and after AO initiation (index date) and no other cancer diagnoses. Adherence was defined using the proportion of days covered (PDC) by AOs during the 6-month period following the index date. Patients with a PDC≥80% were considered adherent. Multivariable logistic regression was used to evaluate baseline characteristics associated with AO adherence. All-cause and PC-related HRU was assessed from 6 to 18 months post-index and compared between adherent and non-adherent patients using multivariable Poisson regression. Results: A total of 27,322 patients initiated on an AO were identified. Most patients were aged ≥65 years (81%), were white (60%), had Medicare coverage (48%), and had metastatic PC (56%). At 6 months, 57% of patients were adherent to AOs. Patients aged 55-64 and 65-74 years had greater odds of being adherent versus those aged ≥75 years (24% and 22%, respectively), while Black patients had 17% lower odds of being adherent relative to white patients (all p<0.01). Medicare coverage was associated with 23% greater odds of being adherent relative to commercial insurance (p<0.01). Patients with a below median primary insurer paid amount for their first AO claim had 13% greater odds of being adherent relative to the above median amount (p<0.05). Adherent patients generally had fewer HRU compared to non-adherent patients. More specifically, adherent patients had 25% fewer all-cause inpatient days, 16% fewer all-cause emergency room (ER) visits, 18% fewer all-cause other non-outpatient services use, as well as 30% fewer PC-related inpatient days and 24% fewer PC-related ER visits (all p<0.01) relative to non-adherent patients. Conclusions: In this study, non-adherence over a 6-month period following AO initiation was associated with substantially higher HRU, including inpatient and ER visits. Moreover, non-adherence was widely observed, impacting over 40% of advanced PC patients in the first 6 months after AO initiation. Identifying factors linked to lower adherence and defining strategies to improve adherence may improve patient outcomes and associated medical resource utilization. (1)Abiraterone acetate plus prednisone is the approved therapy although the combination was not imposed.

Health care resource utilization and costs in metastatic castration-resistant prostate cancer patients treated with enzalutamide or abiraterone acetate.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 232-232
Author(s):  
Vahan Kassabian ◽  
Scott Flanders ◽  
Samuel Wilson ◽  
Bruce A. Brown ◽  
Yan Song ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Resource Utilization ◽  
Index Date ◽  
Linear Models ◽  
Abiraterone Acetate ◽  
Cost Of Care ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Cohort Differences ◽  
Comorbidity Burden

232 Background: Cost of care is an important component of valuation of novel treatments in oncology. Enzalutamide (ENZA) and abiraterone acetate (ABI) are approved hormonal agents for the treatment of metastatic castration-resistant prostate cancer (mCRPC). This study compared healthcare resource utilization (HRU) and costs for patients treated with ENZA or ABI in the U.S. Methods: Adult mCRPC patients initiating ENZA or ABI before and or after cytotoxic chemotherapy were identified from the Truven MarketScan claims database (2012–2015). The first claim of ENZA or ABI was defined as the index date; continuous enrollment ≥6 months before and ≥3 months after the index date was required. HRU and costs were estimated during the post-index period for both cohorts. Generalized linear models compared HRU and costs between the cohorts and were adjusted for baseline demographic and clinical covariates. Analyses were separately conducted for chemo-naïve and chemo-experienced patients. Results: The study included 3230 chemo-naive patients (ENZA 920; ABI 2310) and 692 chemo-experienced patients (ENZA 262; ABI 430). Among chemo-naive patients, ENZA cohort was older (mean age: 74.5 vs 73.5; p=0.013), with a higher proportion of baseline comorbidities vs ABI cohort. During the post-index period, ENZA cohort had fewer all-cause inpatient admissions (IPA) [adjusted incidence rate ratio (IRR) 0.87; p=0.033], all-cause outpatient visits (OPV) [adjusted IRR 0.94; p=0.004], and PC-related OPV (adjusted IRR 0.92; p<0.001) vs the ABI cohort. Within 3 months of the index date, ENZA cohort was less likely to have an all-cause IPA (adjusted odds ratio [OR] 0.75; p=0.029). In addition, ENZA cohort had lower PC-related IPA and emergency department (ED) costs vs ABI cohort. The differences of HRU and medical costs between the 2 cohorts were not statistically significant for chemo-experienced patients. Conclusions: Despite a higher comorbidity burden at baseline, chemo-naive mCRPC patients treated with ENZA incurred less HRU and lower PC-related IPA and ED costs vs ABI cohort. Differences between the 2 cohorts were not statistically significant for chemo-experienced patients.

Efficacy of abiraterone acetate in castration‐resistant metastatic prostate cancer: A real‐world data analysis

2020 ◽  
Author(s):  
Abdilkerim Oyman ◽  
Mustafa Başak ◽  
Melike Özçelik ◽  
Deniz Tataroğlu Özyükseler ◽  
Selver Işık ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Data Analysis ◽  
Real World ◽  
Metastatic Prostate Cancer ◽  
Abiraterone Acetate ◽  
Real World Data ◽  
World Data ◽  
Castration Resistant

Management of Metastatic Castrate-sensitive Prostate Cancer

2018 ◽  
Author(s):  
Derya Tilki ◽  
Marc A Dall’era ◽  
Christopher P Evans
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Survival Benefit ◽  
Metastatic Prostate Cancer ◽  
Oncologic Outcome ◽  
Standard Of Care ◽  
Abiraterone Acetate ◽  
Androgen Deprivation ◽  
Newly Diagnosed ◽  
Treatment Paradigm

Oncologic outcome of patients with newly diagnosed metastatic prostate cancer (mPCa) is poor. The treatment paradigm for newly diagnosed mPCa has changed. The standard of care for men with metastatic hormone-naive prostate cancer has been systemic androgen deprivation therapy (ADT). Previous randomized studies demonstrated an overall survival benefit by the addition of early chemotherapy with six cycles of docetaxel. More recently, results from randomized trials also demonstrated a survival benefit by the addition of abiraterone acetate to the ADT in men with metastatic disease. The aim of this review is to summarize the results from most recent studies, including men with newly diagnosed metastatic hormone-naive prostate cancer, focusing on chemotherapy and ADT. This review contains 1 figure, 2 tables, and 47 references.  Key Words: abiraterone acetate, androgen deprivation therapy, androgen deprivation, castrate sensitive, chemotherapy, continuous androgen deprivation, docetaxel, hormone-naive, intermittent androgen deprivation, metastatic prostate cancer

Androgen Receptor Rediscovered: The New Biology and Targeting the Androgen Receptor Therapeutically

2011 ◽  
Vol 29 (27) ◽  
pp. 3651-3658 ◽  
Author(s):  
Charles J. Ryan ◽  
Donald J. Tindall
Keyword(s):  
Prostate Cancer ◽  
Androgen Receptor ◽  
Clinical Success ◽  
Abiraterone Acetate ◽  
Clinical Findings ◽  
Phase Iii ◽  
Clinical Activity ◽  
Castration Resistant Prostate Cancer ◽  
Androgen Synthesis ◽  
Castration Resistant

Discoveries over the past decade suggest that castration-resistant prostate cancer (CRPC) is sensitive, but not resistant to, further manipulation of the androgen–androgen receptor (AR) axis. Several new therapies that target this axis have demonstrated clinical activity. In this article, preclinical and clinical findings occurring in the field of AR-targeted therapies are reviewed. Reviews of scientific and clinical development are divided into those occurring prereceptor (androgen production and conversion) and at the level of the receptor (AR aberrations and therapies targeting AR directly). Intracrine androgen production and AR amplification, among others, are among the principal aberrancies driving CRPC growth. Phase III data with abiraterone acetate and phase II data with MDV-3100, along with other similar therapies, confirm for the clinician that the scientific findings related to persistent AR signaling in a castrate milieu can be harnessed to produce significant clinical benefit for patients with the disease. Studies aimed at optimizing the timing of their use and exploring the mechanisms of resistance to these therapies are under way. The clinical success of therapies that directly target androgen synthesis as well as the most common aberrancies of the AR confirm that prostate cancer retains dependence on AR signaling, even in the castrate state.

scholarly journals The Potential for Chemotherapy-Free Strategies in Advanced Prostate Cancer

2019 ◽  
Vol 13 (2) ◽  
pp. 57-63 ◽  
Author(s):  
Bulent Cetin ◽  
Ahmet Ozet
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Short Communication ◽  
Unmet Needs ◽  
Abiraterone Acetate ◽  
Clinical Activity ◽  
New Agents ◽  
Chemotherapy Drugs ◽  
Optimal Sequencing ◽  
Radium 223

The treatment landscape for advanced prostate cancer is evolving rapidly, with new agents and strategies, and more optimal use of existing therapies under constant development. Efforts were focused on better understanding of the biology of the disease.This effort has paved the way for a more contemporary and effective therapies to be developed. There are now 6 FDA-approved therapies that increase overall survival. These include the immunotherapy sipuleucel-T; the 2 androgen pathway inhibitors: abiraterone acetate and enzalutamide; 2 chemotherapy drugs: docetaxel and cabazitaxel; and the radionuclide: radium-223. Advanced prostate cancer may be one of the few cancers for which multiple chemotherapy and nonchemotherapy regimens are considered as standard. Several recently published clinical trials have demonstrated the suprising activity of chemotherapy-free strategies, and we should not be too eager to discount these ‘‘old-fashioned'' treatments. Optimal sequencing is still unclear because new therapies have proliferated so quickly that comparative data are limited. In this short communication, we identify current challenges and unmet needs in advanced prostate cancer and provide an overview of their respective clinical activity, while highlighting distinctions between therapies.

The Economic Burden of Pleural Effusions (PE) In Patients with Chronic Myeloid Leukemia (CML).

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3841-3841
Author(s):  
Eric Qiong Wu ◽  
Annie Guerin ◽  
Vamsi Bollu ◽  
Denise Williams ◽  
Amy Guo ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Medical Cost ◽  
Economic Burden ◽  
Regression Models ◽  
Index Date ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Total Medical Cost ◽  
Employment Equity ◽  
Equity Ownership

Abstract Abstract 3841 Background: Ph+ CML patients may develop PE, as an adverse event of some tyrosine kinase inhibitors (TKI) drug therapy. PE is characterized by an excessive accumulation of fluid in the fluid-filled space that surrounds the lungs. PE requires medical care, may compromise the course of CML treatment, and have economic consequence beyond the costs of treating PE. Aim: To compare healthcare resource utilization and costs between CML patients treated with a TKI who developed PE and their matched PE-free controls. Methods: MarketScan and Ingenix Impact databases (2001-2009) were combined to identify adult CML patients (ICD-9CM code 205.1×) who received ≥1 prescription of imatinib, dasatinib, or nilotinib before the index date and had continuous enrollment ≥6 months prior to and after the index date. The index date was defined as 30 days before the first PE diagnosis (ICD-9CM code 511.9×) for patients with PE and was randomly selected among all the eligible calendar dates (i.e., following a prescription for a TKI and a diagnosis for CML) for the PE-free controls. Patients were followed for 6 months after the index date. PE and PE-free patients were matched on a 1:1 ratio using propensity score matching. PE-related (i.e., medical claims with a PE diagnosis) resource utilization (inpatient [IP], outpatient [OP], emergency room [ER] and other medical visits) and costs were estimated for PE patients. To estimate the overall incremental impact of PE, all-cause and CML-related (i.e., medical services associated with a diagnosis code of 205.1×) resource utilization and costs were compared between PE and PE-free controls. All costs were reported in 2009 US dollars. Incidence rate ratios (IRR) for healthcare resource utilization were estimated by Poisson regression models. Incremental costs were estimated using generalized linear models or two-part models. Multivariate regression models controlled for age, gender, treatment duration with tyrosine kinase inhibitor, other chemotherapy, bone marrow or stem cell transplant, CML complexity, Charlson comorbidity index, adverse events, and comorbidities. Results: The study included 179 matched pairs. On average, patients were 63.4 and 63.8 years old with 41% and 49% of the population being female for PE-free and PE patients, respectively. During the study period, PE patients were estimated to have an average of 0.62 PE-related IP admissions, 8.43 IP days, 0.06 ER admissions, and 1.76 OP visits. Compared to PE-free patients, PE patients had more than 7 times as many IP days (IRR=7.23; p<.01), almost 3 times as many IP admissions (IRR=2.96; p<0.01), almost twice as many OP visits (IRR=1.98; p<.01) and ER visits (IRR=1.77; p<.01). Especially, PE patients had almost 10 times as many CML-related IP days (IRR=9.91; p<.01), more than 3 times as many CML-related IP admissions (IRR=3.95; p<0.01), twice as many CML-related OP visits (IRR=2.16; p<.01), and almost 6 times as many CML-related ER visits (IRR=5.60; p<.01). On average, PE-related medical costs were estimated at $11,015 per patient, where 84.2% was accounted for by IP costs. Total costs for all-cause related medical services were estimated at $37,566 for PE patients and $14,841 for PE-free patients. After adjusting for confounding factors, the incremental total medical cost of PE patients was $22,299 (p<.01), mostly due to the incremental OP cost ($12,931; p<.01) and IP cost ($8,737; p<.01). Similarly, PE patients incurred higher CML-related medical costs compared to PE-free patients, with a $15,859 (p<.01) incremental cost. Conclusion: Compared to PE-free patients, PE patients have a substantial economic burden with higher PE-related costs, CML-related costs, and total medical cost. Disclosures: Wu: Analysis Group, Inc.: Employment. Guerin:Analysis Group, Inc.: Employment. Bollu:Novartis: Employment, Equity Ownership. Williams:Novartis: Employment, Equity Ownership. Guo:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Ponce de Leon Barido:Analysis Group, Inc.: Employment. Yu:Analysis Group, Inc.: Employment.

Refill gaps and dose reductions in patients treated with abiraterone acetate plus prednisone (AA+P) or enzalutamide (ENZ).

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e572-e572
Author(s):  
Dominic Pilon ◽  
Ajay S. Behl ◽  
Bruno Emond ◽  
Yongling Xiao ◽  
Patrick Lefebvre ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Index Date ◽  
Standard Dose ◽  
Package Insert ◽  
Dose Intensity ◽  
Treatment Interruption ◽  
Abiraterone Acetate ◽  
Castrate Resistant ◽  
Dose Reductions ◽  
Delivered Dose

e572 Background: Recently available treatmentssuch as AA+P or ENZ have improved survival and quality of life for patients with metastatic castrate resistant prostate cancer (mCRPC). However, drug-drug interactions, intolerance or toxicities can potentially lead to dose reductions or treatment interruption. This study assessed refill gaps and dose reduction events in patients treated with AA+P or ENZ. Methods: The MarketScan databases (03/2012-10/2015) were used to conduct a retrospective analysis. Patients initiated on AA+P or ENZ (index date) after 09/2012 with ≥ 6 months of continuous eligibility prior to index date and ≥ 1 diagnosis for prostate cancer were included. Inverse probability of treatment weighting (IPTW) was used to adjust for observed baseline confounders between groups. Weighted Kaplan-Meier (KM) rates and Cox proportional hazard models were used to compare the occurrence of refill gaps ( ≥ 14, ≥ 30, or ≥ 60 days) or dose reductions (i.e., relative dose intensity [RDI] ≤ 80%, and ≤ 85%) between groups. RDI was calculated as the ratio of the delivered dose intensity (total delivered dose divided by the period over which the total dose was measured) to the standard dose intensity as recommended in the package insert for AA+P or ENZ. Results: A total of 2,540 AA+P and 1,265 ENZ patients were identified. IPTW resulted in balanced baseline demographic, comorbidities, and disease characteristics. At 12 months post-index, patients initiated on ENZ were more likely to have an RDI ≤ 80% or ≤ 85% or to have a refill gap ≥ 30 or ≥ 60 days when compared to patients initiated on AA+P (Table). Conclusions: This study showed that mCRPC patients treated with ENZ were more likely to experience a refill gap and to reduce their treatment dose than patients treated with AA+P. [Table: see text]

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