Out-of-Pocket Spending Not Associated with Oral Oncolytic Survival Benefit

Abstract

Background: With total and out-of-pocket spending for oral oncolytics rising, there is increased interest in choosing oncology treatments based on their clinical value relative to cost. Objectives: We sought to determine if out-of-pocket spending varied for higher versus lower benefit oral oncology drugs reimbursed by commercial insurers. Methods: This was a retrospective analysis of commercial insurer prescription drug claims filed between 2007–2014 for 13 oral oncolytics approved before 2009. We calculated mean monthly out-of-pocket payment for each fill by patient. We then categorized oral oncolytics by their overall and progression-free survival benefits for each FDA-approved indication, using evidence from published studies. We assessed the relationship of survival benefit with mean monthly out-of-pocket payment, adjusting for demographic and plan characteristics. Results: Our population included 44,113 patients ages 18–65 (mean 52.5; SD: 9.4) with a cancer diagnosis who filled 731,354 prescriptions. The most commonly represented oncolytics were imatinib (37.4% of fills), lenalidomide (17.7% of fills), and dasatinib (10.0% of fills). Approximately 32.3% of fills were for drug-indication pairs with an overall survival benefit of 4+ years. In adjusted analyses, there was no clear pattern to suggest that out-of-pocket payments differed with drugs’ indication-specific survival benefits. Drugs for indications providing > 0 to 1 year of overall survival benefit were significantly more likely to have a lower out-of-pocket payment versus those prescribed off-label, but there were no significant differences in out-of-pocket payments between drugs and associated indications in any other survival category versus drugs used off-label. Conclusions: Out-of-pocket payments for oral oncolytics were not clearly related to indication-specific value in commercially insured patients. This suggests that despite increased attention to value- and indication-based drug pricing, cost-sharing for oral oncolytics does not currently reflect these goals.

Divergent Patterns in Care Utilization and Financial Distress between Patients with Blood Cancers and Solid Tumors: A National Health Interview Survey Study, 2014–2020

“…Due to the lack of patient-reported financial toxicity measures in all-claims databases [ 13 , 14 , 15 , 23 , 24 ] and SEER, we utilized NHIS to examine the association between medical care utilization and cancer type with patient-reported financial barriers and financial distress. We found that increased medical care utilization is associated with increased financial barriers, but no significant associations were seen with financial distress.…”

“…Importantly, financial toxicity is only incompletely assessed by using all-claims out-of-pocket copayment data, as these databases do not capture the extent of financial barriers experienced by the patient. Thus, studies utilizing these databases [ 13 , 14 , 15 ] provide an incomplete picture of financial toxicity. On the other hand, large national databases, such as the Surveillance, Epidemiology, and End Results Program (SEER) contain detailed cancer-specific diagnostic and treatment information but no care utilization or financial data.…”