Financial toxicity thwarts project aimed at preventing VTE in women with gynecologic cancer
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Key takeaways:
- VTE education and risk assessment rates increased from 0% to 100% within 3 months of the model’s implementation.
- Patients on Medicare incurred an average monthly copay of $290.
A quality improvement model successfully identified, educated and treated newly diagnosed women with gynecologic cancer at high risk for venous thromboembolism, according to study results.
However, financial concerns prompted researchers to suspend the project 3 months earlier than planned.
“Due to unanticipated financial burden imposed on patients and our health care institution, our project was suspended,” Ran C. Zhang, MD, MPH, of the department of obstetrics and gynecology at University of Wisconsin School of Medicine and Public Health, and colleagues wrote. “Interventions are needed to address this financial toxicity.”
Background and methodology
Society of Gynecologic Oncology guidelines and others recommend VTE thromboprophylaxis for high-risk women with gynecologic cancer undergoing systemic cytotoxic chemotherapy.
Zhang and colleagues conducted a prospective quality improvement project to determine the feasibility of using direct oral anticoagulants for VTE prevention among this population. The researchers considered factors such as ability to obtain insurance authorization, adherence to the regimen and adverse events associated with prophylactic anticoagulation.
Patients who met inclusion criteria received prophylactic anticoagulation with direct oral anticoagulants throughout the duration of their primary cytotoxic therapy.
Patients excluded from the study included those with recurrent cancer, a secondary active cancer, or a Khorana score less than 2, and as well as those receiving therapeutic anticoagulation at the time of cancer diagnosis or with contraindications to anticoagulation did not participate in the study.
Data collection took place from July 2021 to July 2022.
Results
About 40% (n = 28) of the 71 women met the criteria to be included in the study. Two of them declined to participate.
Within 3 months of the model’s implementation, VTE education and risk assessment rates increased from 0% to 100%.
Most high-risk patients (93%) who received counseling agreed to prophylactic oral anticoagulation.
Patients on Medicare (more than 33% of eligible population) incurred an average monthly copay of $290 (interquartile range, 47-527), with much of that cost covered through the study’s financial assistance program, according to researchers. However, the project was suspended after 9 months because of financial concerns, despite initial plans for the project to run for a full year.
Zhang and colleagues noted that rates of VTE education and risk assessment remained high at 80% at the time of termination.
Collapse
Zhang RC, et al. Poster 162. Presented at: Society of Gynecologic Oncology Annual Meeting on Women’s Cancer; March 25-28, 2023; Tampa, Florida.
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