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High out-of-pocket costs may lead to low TKI adherence in older patients with CML
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Approximately 40% of older patients with chronic myeloid leukemia did not initiate tyrosine kinase inhibitor therapy within the first 6 months of diagnosis due to high out-of-pocket costs, according to a study published in Journal of Clinical Oncology.
However, those with cost-sharing subsidies initiated treatment sooner than those without.
“There has been a dramatic increase in the number of orally administered oncology treatments in recent years,” Stacie B. Dusetzina, PhD, assistant professor in the division of pharmaceutical outcomes and policy at University of North Carolina at Chapel Hill, and colleagues wrote.
“With this transition away from office-based infusions, it is important to identify potential gaps in adherence to therapies, because the risks for primary nonadherence (never filling) and secondary nonadherence (discontinuing or using less supply than expected) increase when patients are obtaining drugs outside of the infusion center.”
Medicare beneficiaries face high out-of-pocket costs with the initiation of TKI therapy. The average age of patients diagnosed with Philadelphia chromosome–positive CML is 64 years — which makes them eligible for Medicare — and these patients are highly recommended to use TKI therapy for an extended period of time.
If high out-of-pocket costs contribute to low treatment adherence in this patient population, response to treatment and outcomes can be poorer.
“Given the critical role of TKIs for patients with CML, it is important to understand whether cost-sharing or other patient- or provider-level factors act as a barrier to treatment use,” the researchers wrote.
Dusetzina and colleagues used SEER-Medicare data to estimate the rates of TKI initiation and their associations with adherence among 393 Medicare beneficiaries (mean age at diagnosis, 77 years) diagnosed with CML from 2007 to 2011.
Approximately 40% of individuals received cost-sharing subsidies. The median time to initiation of TKI treatment among initiators was 75 days. The median time to initiation was 58 days in patients who received cost-sharing subsidies and 108 days in those who did not (P = .04).
“It is possible that patients without prescription drug cost-sharing subsidies may delay initiating treatment as they work to obtain funds to cover these high upfront costs,” the researchers wrote. “Additionally, these individuals may also delay treatment initiation in the hope of receiving financial assistance from a patient assistance program or foundation.”
Overall, 68.2% of patients with newly diagnosed CML initiated TKI treatment within 180 days after diagnosis.
Multivariate analysis showed later year of diagnosis (adjusted RR per year = 1.06; 95% CI, 1-1.11) and residence in a large metropolitan area compared with an urban area (adjusted RR = 1.57; 95% CI, 1.03-2.49) were associated with increased use of TKIs. Patients aged 80 years or older had a reduced use of TKIs (adjusted RR = 0.71; 95% CI, 0.58-0.85) compared with those aged 70 years or younger.
Sixty-one percent of patients who initiated TKI treatment reported adherence to therapy during the first 180 days following the start of treatment, defined as a proportion of days covered of 80% or greater.
Patients aged 80 years or older were less likely to adhere to therapy (adjusted RR = 0.74; 95% CI, 0.56-0.94) than patients aged 70 years or younger. A later year of diagnosis also was associated with higher adherence (adjusted RR per year = 1.07; 95% CI, 1.01-1.13).
“Our findings highlight important gaps in TKI use among Medicare beneficiaries with CML and suggest that high cost sharing may result in delays in initiation of these life-saving medications,” the researchers wrote. – by Kristie L. Kahl
Disclosure: The researchers report no relevant financial disclosures.
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