Association Between Prescription Co-Payment Amount and Compliance With Adjuvant Hormonal Therapy in Women With Early-Stage Breast Cancer

Abstract

A B S T R A C T PurposeNoncompliance with adjuvant hormonal therapy among women with breast cancer is common. Little is known about the impact of financial factors, such as co-payments, on noncompliance. Patients and MethodsWe conducted a retrospective cohort study by using the pharmacy and medical claims database at Medco Health Solutions. Women older than age 50 years who were taking aromatase inhibitors (AIs) for resected breast cancer with two or more mail-order prescriptions, from January 1, 2007, to December 31, 2008, were identified. Patients who were eligible for Medicare were analyzed separately. Nonpersistence was defined as a prescription supply gap of more than 45 days without subsequent refill. Nonadherence was defined as a medication possession ratio less than 80% of eligible days. ResultsOf 8,110 women younger than age 65 years, 1,721 (21.1%) were nonpersistent and 863 (10.6%) were nonadherent. Among 14,050 women age 65 years or older, 3,476 (24.7%) were nonpersistent and 1,248 (8.9%) were nonadherent. In a multivariate analysis, nonpersistence (ever/never) in both age groups was associated with older age, having a non-oncologist write the prescription, and having a higher number of other prescriptions. Compared with a co-payment of less than $30, a co-payment of $30 to $89.99 for a 90-day prescription was associated with less persistence in women age 65 years or older (odds ratio [OR], 0.69; 95% CI, 0.62 to 0.75) but not among women younger than age 65, although a co-payment of more than $90 was associated with less persistence both in women younger than age 65 (OR, 0.82; 95% CI, 0.72 to 0.94) and those age 65 years or older (OR, 0.72; 95% CI, 0.65 to 0.80). Similar results were seen with nonadherence. ConclusionWe found that higher prescription co-payments were associated with both nonpersistence and nonadherence to AIs. This relationship was stronger in older women. Because noncompliance is associated with worse outcomes, future policy efforts should be directed toward interventions that would help patients with financial difficulties obtain life-saving medications.

Fatores associados à adesão e à persistência na hormonioterapia em mulheres com câncer de mama

“…Among the variety of methods to estimate the A & P, those based on retrospective data are still more used due to their easiness of calculation and low cost, besides presenting closer rates to the real ones, when compared with studies that use direct methods to determine such behaviors 14,28,29 . Regarding persistence estimates, we need to relativize the results, given the adopted concept considers the interruption of treatment for more than or 60 days.…”

Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program

“…Patients with cancer experience greater financial burden, higher out-ofpocket expenses, and are at increased risk for bankruptcy compared with patients without cancer [17,21]. Additionally, studies have demonstrated that patients experiencing financial burden may jeopardize their medical care by forgoing recommended treatments [22][23][24]. Thus, the financial burden experienced by patients with cancer has been called a toxic side effect of their care [19].…”

Obstacles to Affordable Cancer Treatments

“…High out-of-pocket costs have been cited as one possible reason for inadequate use of oral cancer therapies [19,20]. For example, chronic myeloid leukemia is a condition for which even small lapses in adherence are associated with poor outcomes.…”