Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors

Abstract

PURPOSE: The relationship between out-of-pocket spending and cost-related medication nonadherence among older rural- and urban-dwelling cancer survivors is not well understood. METHODS: This retrospective cohort study used the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource linked data (2007-2015) to investigate the relationship between cancer survivors' cost responsibility in the year before and after report of delaying or not filling a prescription medication because of cost in the past 6 months (cost-related medication nonadherence). Secondary exposures and outcomes included Medicare spending and utilization. Generalized linear models assessed bidirectional relationships between cost-related medication nonadherence, spending, and utilization. Effects of residence were assessed via interaction terms. RESULTS: Of 6,591 older cancer survivors, 13% reported cost-related medication nonadherence. Survivors were a median 8 years (interquartile range, 4.5-12.5 years) from their cancer diagnosis, 15% were dually Medicare/Medicaid-eligible, and prostate (40%) and breast (32%) cancer survivors were most prevalent. With every $500 USD increase in patient cost responsibility, risk of cost-related medication nonadherence increased by 3% (risk ratio, 1.03; 95% CI, 1.02 to 1.04). After report of cost-related medication nonadherence, patient cost responsibility was 22% higher (95% CI, 1.11 to 1.32) compared with those not reporting nonadherence, amounting to $523 USD (95% CI, $430 USD to $630 USD). Medicare spending and utilization were also higher before and after report of cost-related nonadherence versus none. For survivors residing in rural (18%) and urban (82%) areas, residence did not modify adherence or cost outcomes. CONCLUSION: A bidirectional relationship exists between patient cost responsibility and cost-related medication nonadherence. Interventions reducing urban- and rural-dwelling survivor health care costs and cost-related adherence barriers are needed.

Assessing a Pharmacist-Enabled Intervention to Improve Adherence to Medication for Hypertension, Dyslipidemia, and Chronic Venous Circulation Disorders in Greece

“…This is important as it refers to a condition for which patients must cover treatment cost out of their pocket, which has been shown to be a barrier to adherence. 30,31 As the majority of patients in our study were aged 55-75, our findings are in line with previous meta-analyses on the impact of pharmacists' interventions in older patients' adherence. Marcum et al concluded that irrespective of type, pharmacist-led interventions resulted in a significant improvement in adherence to medication in older adults.…”

“…This is important as it refers to a condition for which patients must cover treatment cost out of their pocket, which has been shown to be a barrier to adherence. 30 , 31 …”

Understanding the financial cost of cancer clinical trial participation

“…This cross‐sectional study of a diverse sample of patients receiving support from PAF found cancer clinical trial‐related financial hardship, most often stemming from travel expenses, affects almost half of trial‐enrolled patients. Though financial hardship is a well‐documented adverse effect of standard‐of‐care cancer treatment, 25 , 26 , 27 , 28 , 29 this is one of the few studies to report on and quantify financial hardship and its impact on patients with lower incomes considering or participating in cancer clinical trials. Additionally, this study provides data on measures of both subjective financial hardship, or affordability, and objective financial hardship, or actual costs, as both are important in understanding potential financial barriers to clinical trial participation.…”

Cancer-Related Financial Hardship Screening as Part of Practice Transformation

“…21 Thus, longitudinal financial hardship screening throughout treatment and into survivorship is needed to identify and mitigate financial hardship as patients incur more medical and nonmedical bills related to their cancer care. [22][23][24][25][26][27] Collection of patient economic data is also critical for tailored intervention development for health care systems in geographic areas where systemic issues, such as persistent poverty, Medicaid politics, and structural racism, create barriers to cancer care delivery. Notably, our sample is not nationally representative since 17% of Alabamians live below the federal poverty threshold compared with the national average of 13%.…”

“…This finding is alarming since a recent study estimated 42% of individuals with cancer depleted their entire life assets within 2 years of their cancer diagnosis 21 . Thus, longitudinal financial hardship screening throughout treatment and into survivorship is needed to identify and mitigate financial hardship as patients incur more medical and nonmedical bills related to their cancer care 22–27 …”