Anticancer-drug dose changes, discontinuations lead to $4,290 in pill wastage per patient
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Key takeaways:
- The wastage cost represents a mean 1.78% of the total cost of treatment.
- Researchers suggested further study of pricing strategies and drug switching to reduce wastage.
Wastage from dose reduction or discontinuation of the most common oral anticancer drugs costs a mean $4,290 per patient, results of a retrospective study showed.
The findings, published in JAMA Oncology, showed drug wastage accounted for a mean 1.78% (± 2.21%) of the total cost of treatment.
“The cost in wastage generated by oral anticancer pills is critical given rises in anticancer drug prices and the recognized burden of financial toxicity for patients with cancer,” Michael Lam, PharmD, of UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, and colleagues wrote.
“The cost of cancer treatment continues to rise rapidly while household income remains relatively flat,” they added. “This could result in a disproportionate burden for patients who are expected to pay for an increasing gap in coverage with no concomitant increase in wages.”
Background
Previous studies have shown that oversized single-dose vials of IV chemotherapy drugs can cost patients with cancer in the United States more than $1 billion per year in waste due to discarded extra contents, according to Lam and colleagues.
“There is a possibility that pills are wasted whenever patients develop adverse effects that lead to dose reductions,” they wrote, noting that patients often discard pills at strengths that are unusable at a subsequent lower dose level.
“The cost of wastage from oral chemotherapy dose modification is often unreported,” Lam and colleagues added.
Methodology
Lam and colleagues aimed to quantify the cost of wastage associated with dose modification and discontinuation of popular oral anticancer drugs sold in the United States.
The researchers conducted a retrospective cross-sectional analysis of oral anticancer drugs the FDA approved between Jan. 1., 2020, and Aug. 31, 2022, plus a list of the top 50 selling oral anticancer agents in 2021.
Investigators used the Micromedex RED BOOK database to determine the monthly cost of each drug while acquiring registrational trial data from the FDA prescribing information or original clinical trial publication.
The cost of wastage for selected oral anticancer drugs due to dose reduction or treatment discontinuation served as the study’s primary outcome measurement, with the percentage of wastage in comparison with the overall treatment cost as the secondary outcome measurement.
Key findings
The final analysis included 22 oral anticancer medications with data from 35 clinical trials.
Investigators reported a median cost of wastage from dose reduction and discontinuation of oral medication of $1,751 (range, $43-$27,200) per patient, with a mean of $4,290 (± $5,720) per patient.
Meanwhile, researchers noted median 1.04% wastage (range, 0.04-10.8) from the total cost of treatment, with a mean 1.78% (± 2.21%).
Avapritinib (Ayvakit, Blueprint Medicines), infigratinib (Truseltiq, QED Therapeutics), pemigatinib (Pemazyre, Incyte), olaparib (Lynparza, AstraZeneca) and tivozanib (Fotivda, AVEO Pharmaceuticals) had the highest wastage cost per patient, with avapritinib for treatment of advanced systemic mastocytosis having the highest wastage cost, at $27,200 per patient, because of high cost per bottle, multiple dose reduction levels at different pill strengths and a high rate of dose reduction.
Conversely, relugolix had the lowest cost of wastage, at $43 per patient.
Clinical implications
“Oral anticancer drugs offer many advantages and convenience compared with intravenous anticancer medications,” Lam and colleagues wrote. “However, this economic evaluation found that disadvantages of oral medication include prespecified and limited pill strengths, which when paired with dose reductions may result in wastage.”
To help alleviate the cost associated with oral medication wastage, the researchers suggested drugmakers develop dose strengths that can be reused at each dosing level or packaging that allows for more than one dose strength.
There were also several mitigation strategies they suggested for clinicians and payers, including rebates for unused pills or a more hands-on approach for clinics in the prescribing process.
“Ultimately,” the researchers concluded, “real cost savings may occur through better stewardship of oral anticancer prescribing.”
Results showing that wastage can account for nearly 2% of the cost of treatment are worthy of the attention of patients and payers, according to Cathy J. Bradley, PhD, MPA, of University of Colorado Comprehensive Cancer Center, and colleagues.
However, as they noted in an accompanying editorial, clinicians have been required to report — often in an inconsistent fashion — the amount of anticancer infusion drugs they discard when billing under Medicare Part B. This has caused additional administrative burden that has added to the overall cost of cancer care, they noted.
“Furthermore, we caution that policies that incentivize drug developers to alter their approach to development and manufacturing or require rebates will be met with challenges,” Bradley and colleagues wrote.
“Currently, drug manufacturers can set drug prices without consideration of the financial consequences of dose modifications or discontinuation,” they added. “In response to any policies to rebate or reimburse for discarded drugs, drug developers could further increase prices, which would inflict additional financial burden on patients and the health care system. Therefore, it is difficult to predict whether any financial savings could occur, especially with the additional administrative burden associated with recording and reporting the volume of discarded drugs.”
References:
- Bradley CJ, et al. JAMA Oncol. 2023;doi:10.1001/jamaoncol.2023.2226.
- Lam M, et al. JAMA Oncol. 2023;doi:10.1001/jamaoncol.2023.2306.
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Lam M, et al. JAMA Oncol. 2023;doi:10.1001/jamaoncol.2023.2306.
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