scholarly journals Treatment utilization patterns of newly initiated oral anticancer agents in a national sample of Medicare beneficiaries

2021 ◽  
Vol 27 (10) ◽  
pp. 1457-1468
Author(s):  
Jalpa A Doshi ◽  
Jordan Jahnke ◽  
Swathi Raman ◽  
Justin T Puckett ◽  
Victoria T Brown ◽  
...  
Keyword(s):  
Anticancer Agents ◽  
National Sample ◽  
Treatment Utilization ◽  
Medicare Beneficiaries ◽  
Utilization Patterns ◽  
Oral Anticancer Agents

scholarly journals Use of Charity Financial Assistance for Novel Oral Anticancer Agents

2018 ◽  
Vol 14 (4) ◽  
pp. e221-e228 ◽  
Author(s):  
Adam J. Olszewski ◽  
Andrew R. Zullo ◽  
Christopher R. Nering ◽  
Justin P. Huynh
Keyword(s):  
Anticancer Agents ◽  
The United States ◽  
Financial Assistance ◽  
Medicare Beneficiaries ◽  
Academic Center ◽  
Health Care Policies ◽  
Specialty Pharmacy ◽  
Using Data ◽  
Insured Patients ◽  
Oral Anticancer Agents

Novel oral targeted drugs are increasingly used for cancer therapy, but their extreme cost, often exceeding $10,000 per month, poses a significant barrier for patients and insurers alike, leading to the potential breakdown of traditional cost-sharing strategies. Insured patients’ routine use of charity assistance to supplement their coverage would indicate a major deficiency in the current health care policies. By using data from a specialty pharmacy affiliated with an academic center (1,557 prescriptions dispensed between January 2014 and March 2017), we examined sources of payment for novel oral anticancer agents, distinguishing contributions from health insurance, patients, and from charitable assistance organizations. Thirty-six percent of 211 patients received charity assistance, including 47% of patients who were 65 years old or older. Charity sources covered 4% of total drug costs and 64% of out-of-pocket expenditures. The proportion of patients receiving financial assistance ranged from 7% when the upfront out-of-pocket requirement was less than $100 to 67% when it exceeded $1,000. When patients’ out-of-pocket requirement exceeded $1,000, the median direct cash contribution paradoxically fell to $0 because of extensive use of charity support. Receipt of upfront charity assistance was associated with a longer time to filling the first prescription (median 9 v 7 days; P = .011) and with longer overall duration of therapy (median, 261 v 134 days; P = .014). These findings indicate that high out-of-pocket burden for expensive novel oral anticancer drugs leads to widespread use of charity support in the United States and that a significant financial barrier disparately affects older Medicare beneficiaries.

scholarly journals Real-World Utilization of Oral Anticancer Agents Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States

Kidney Cancer ◽  
2021 ◽  
pp. 1-13
Author(s):  
Lauren E. Wilson ◽  
Lisa Spees ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Charles D. Scales ◽  
...  
Keyword(s):  
United States ◽  
Anticancer Agents ◽  
Patient Characteristics ◽  
The United States ◽  
Socioeconomic Indicators ◽  
Economic Implications ◽  
Southern Us ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Oral Anticancer Agents

Background: Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population. Methods: Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars. Results: 2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (>  80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477. Conclusion: Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

Cancer incidence and treatment utilization patterns at a regional cancer center in Tanzania from 2008-2016: Initial report of 2,772 cases

2020 ◽  
Vol 67 ◽  
pp. 101772 ◽  
Author(s):  
Adam C. Olson ◽  
Franco Afyusisye ◽  
Joe Egger ◽  
David Noyd ◽  
Beda Likonda ◽  
...  
Keyword(s):  
Cancer Incidence ◽  
Cancer Center ◽  
Treatment Utilization ◽  
Initial Report ◽  
Utilization Patterns

scholarly journals 972 Predictors and Outcomes of Readmission for Clostridium difficile in a National Sample of Medicare Beneficiaries

2014 ◽  
Vol 146 (5) ◽  
pp. S-1032 ◽  
Author(s):  
Courtney Collins ◽  
M. Didem Ayturk ◽  
Frederick A. Anderson ◽  
Heena P. Santry
Keyword(s):  
Clostridium Difficile ◽  
National Sample ◽  
Medicare Beneficiaries

scholarly journals Gender Differences in 30-Day Re-Hospitalization Among Medicare Beneficiaries With Alzheimer’s and Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 697-697
Author(s):  
Andrea Gilmore-Bykovskyi
Keyword(s):  
Gender Differences ◽  
Cognitive Decline ◽  
Primary Outcome ◽  
African American Men ◽  
White Men ◽  
National Sample ◽  
Medicare Beneficiaries ◽  
Index Hospitalization ◽  
The Impact ◽  
Racial Ethnic

Abstract Hospitalization is associated with accelerated cognitive decline for persons with Alzheimer’s disease and related dementia (ADRD), which disproportionately impacts women. Persons with ADRD are also at higher risk for 30-day rehospitalization, which may compound the impact of hospitalization-related exposures that precipitate decline. Evidence surrounding the intersections between gender and rehospitalization risk among diverse, representative populations with ADRD are lacking. This retrospective cohort study used a 100% national sample of Medicare beneficiaries with a diagnosis of ADRD and qualifying index hospitalization in 2014 (n= 1,033,144 unique beneficiaries and 1,672,238 unique stays). The primary outcome was rate of 30-day rehospitalization by gender and race. Within each racial group, men have higher rehospitalization rates than women: 2.6% higher among white men, 1.7% among African American men, and 2.6% higher among other racial/ethnic minorities. Findings highlight the importance of elucidating mechanisms underlying gender differences in hospital utilization and subsequent impact on cognitive decline.

Primary care oncology model (PCOM): Implementation of a model integrating primary and oncology care for patients taking oral anticancer agents.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS1587-TPS1587
Author(s):  
Emily R. Mackler ◽  
Karen B. Farris ◽  
Katie S. Gatwood ◽  
Amna Rizvi-Toner ◽  
Alex Wallace ◽  
...  
Keyword(s):  
Primary Care ◽  
Anticancer Agents ◽  
Chronic Conditions ◽  
Lymphocytic Leukemia ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Hiv Intervention ◽  
Patient Reported ◽  
Chronic Medications ◽  
Oral Anticancer Agents

TPS1587 Background: Non-adherence to oral anticancer agents (OAA) has been reported among 30% of individuals. Often, individuals with cancer are not just managing their new OAA but also medications to treat multiple chronic conditions (MCC). Multiple factors contribute to the extent patients on OAAs and MCC medications adhere to therapy. The objective of this study is to improve medication, symptom, and disease management of patients with hematological malignancies and MCC through care coordination between pharmacists. Methods: Design. This is a multi-center prospective single arm pilot study at two academic medical centers in Michigan and Tennessee. Subjects. Ninety participants will be recruited, 60 from site 1 and 30 from site 2. Inclusion criteria are: adults > 18 years, diagnosed with and initiating oral treatment for chronic myeloid leukemia, chronic lymphocytic leukemia, or multiple myeloma, diagnoses of at least 2 chronic conditions, where one is type 2 diabetes, hypertension, congestive heart failure, depression/anxiety, gastroesophageal reflux disease, hyperlipidemia, or chronic obstructive pulmonary disease, taking at least two chronic medications, and able to provide electronic consent. Exclusion criteria are: inability to speak English, and diagnosis of type 1 diabetes or HIV. Intervention. Participants will complete two Patient Reported Outcome Measures (PROMs) for their OAA that will be reviewed by the oncology pharmacist, with follow-up to the care team if needed. Participants will be scheduled for a Comprehensive Medication Review with a primary care pharmacist for up to two visits for their chronic medications. The intervention over 2 months, and the oncology and primary care pharmacists communicate via electronic health record about medications, symptoms, and disease control. Outcomes. The primary endpoints are (a) dose-adjusted adherence by proportion days covered (PDC) for the OAA and (b) PDC for chronic condition medications, assessed using 6 months of prescription claims. Data will be collected from patients using REDCap surveys and abstracted data will be entered into REDCap. Implementation by pharmacists and patient acceptability will be examined. Analysis. The association of OAA and chronic medication adherence (PDC) will be examined via correlation. Participant demographics,clinical characteristics, and the symptom experience from the PROM will be described. Using CMR results, medication problems, recommendations, and changes will be provided. Program implementation will be assessed and patient perceptions obtained from post-CMR interviews. A joint display for the quantitative and qualitative data for feasibility, appropriateness, and acceptability from pharmacists will be completed. Results: Screening and recruitment has begun. Clinical trial information: NCT04595851 and NCT04663100.

scholarly journals National Rates of Warfarin Use in Medicare Patients with Atrial Fibrillation: Results from the National Stroke Project

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 328-328
Author(s):  
David S Nilasena ◽  
Timothy F Kresowik ◽  
Anton F Piskac ◽  
Rebecca A Hemann ◽  
Marian A Brenton ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Warfarin Therapy ◽  
District Of Columbia ◽  
National Sample ◽  
The State ◽  
Medicare Beneficiaries ◽  
Medicare Patients ◽  
Project Data ◽  
Demographic Subgroups ◽  
Univariate Analyses

66 Background: The National Stroke Project is a HCFA initiative to improve stroke related hospital care for Medicare beneficiaries. As part of the evaluation of these efforts, HCFA is measuring performance on a set of quality indicators at the state and national levels. We report the baseline results for a key quality indicator for this project: warfarin at discharge for patients with atrial fibrillation (AF). Methods: Project data were abstracted from a national sample of Medicare inpatient charts with a principal or secondary diagnosis of AF (ICD-9-CM 427.31) and discharged between 4/98 and 3/99. All U.S. states, the District of Columbia, and Puerto Rico were sampled using a systematic random approach. Eligible patients were required to have physician confirmation of AF during the hospitalization and at discharge, or intermittent AF. The main outcome measure was a prescription or physician documented plan for warfarin at discharge. Results: Of 38,925 cases reviewed, 12,303 met the inclusion criteria. Many of the cases (38.3%) were excluded due to a history or current finding of hemorrhage. Nationwide, 6,633 (unadjusted rate, 53.9%) patients were prescribed warfarin at discharge or had a plan to start warfarin after discharge. The state-specific rates ranged from 30.7% to 65.3%. Univariate analyses showed that warfarin was prescribed less frequently (p<0.002) for adults 85 years of age and older (rate=39.9%, OR=0.47, 95% CI=0.43–0.51) and women (rate=52.0%, OR=0.83, 95% CI=0.78–0.90). African-Americans (rate=47.2%, OR=0.76 95% CI=0.63–0.90) and Asians (n=108, rate=37.0%, OR=0.50, 95% CI=0.34–0.74) were also found to have lower warfarin therapy rates. Conclusions: The results from this large national sample confirm the findings from other reports that there is substantial under-utilization of warfarin therapy for stroke prevention among Medicare patients with AF. This is particularly true for demographic subgroups at high risk for stroke. Quality improvement efforts are currently underway through HCFA’s National Stroke Project (AF topic) to increase warfarin use in appropriate AF patients.

Adherence enhancing interventions for oral anticancer agents: A systematic review

2014 ◽  
Vol 40 (1) ◽  
pp. 102-108 ◽  
Author(s):  
Tim Mathes ◽  
Sunya-Lee Antoine ◽  
Dawid Pieper ◽  
Michaela Eikermann
Keyword(s):  
Systematic Review ◽  
Anticancer Agents ◽  
Oral Anticancer Agents
Sign in / Sign up

Export Citation Format

Share Document