Deirdre Fuller, Oncology Roundtable
A cancer diagnosis has always come with a steep price tag, and patients’ out-of-pocket costs will only increase as drug prices climb and insurers shift financial responsibility onto patients. However, a recent study in JCO suggests there may be an even more devastating consequence.
Tyrosine kinase inhibitors prolong life, but at a high price
Before the discovery of tyrosine kinase inhibitors (TKIs), the median survival rate for patients with chronic myeloid leukemia (CML) was 5-6 years. Now, many CML patients who receive and adhere to TKI therapy can live almost full life spans.
Unfortunately, despite its proven clinical benefits, at least 30% of CML patients are non-adherent to TKI therapy. Non-adherence to TKIs is particularly problematic because it can lead to the development of aggressive, TKI-resistant CML. There are a number of reasons for non-adherence, but a leading culprit is high costs. The cost of TKI therapy has skyrocketed since its introduction.
In 2001, the TKI imatinib was already one of the most expensive drugs available, costing $30,000 per year. By 2012, that price tag had tripled to $92,000 per year. What remains poorly understood, however, is how these soaring prices affect patients' out-of-pocket costs and their adherence to treatment.
Rising drug costs drive up patient copays
To study trends in patient expenses for TKIs, researchers identified over 1,500 imatinib users between the ages of 18-64 with continuous health plan enrollment between 2001 and 2011.
Over the ten-year study period, the mean copay required for a 30-day supply of imatinib was $108 (standard deviation, $301). Monthly copays increased from an average of $55 in 2002 to $145 in 2010—an increase mirroring the rising price of imatinib during that time.
Higher copays increase risk of discontinuation, non-adherence
Researchers also found that higher copays increased the risk of discontinuing TKI therapy. For new imatinib users, there was a 70% increase in the risk of discontinuing therapy during the first 180 days of treatment among patients with relatively higher copays. Similarly, patients with higher copays were 42% more likely to be non-adherent to their TKI therapy regimen.
Non-adherence a major concern as use of oral therapies increases
Patient non-adherence to therapy is becoming more of a concern for providers as oral therapies become more common. In fact, oral agents account for an estimated 25%-35% of the current oncology pipeline.
While oral medications are more convenient for patients, they also move therapy outside of the cancer center and beyond providers’ direct control, which leads to a whole new set of obstacles that stand in the way of making sure patients receive their full course of therapy.
As this study suggests, out-of-pocket costs represent one serious obstacle. Providers may not be able to control the price of drugs or patients’ health benefits, but they can have open discussions with patients about the costs of treatment and implement strategies to improve patient management.
More on Patient Finances
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For best practices on improving oral chemotherapy adherence, read our study, Redesigning Cancer Care Delivery for the Era of Accountability, or check out this on-demand webconference.