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Patient out-of-pocket payments for oral oncolytics: results from a 2009 US claims data analysis.
- Source :
-
The American journal of managed care [Am J Manag Care] 2012 May; Vol. 18 (5 Spec No. 2), pp. SP57-64. - Publication Year :
- 2012
-
Abstract
- Objectives: Oral oncolytics are an increasingly important treatment option for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket (OOP) cost burden for patients. The purpose of this study was to evaluate patient OOP payments for oral oncolytic therapies in US managed care plans.<br />Materials and Methods: Patients aged >18 years who received 1 of 21 oral oncolytics were identified in 2009 US claims; the first oral therapy was the index therapy. OOP payments were calculated as the allowed amount (dollar amount a health plan allows for a therapy, including member liability) minus the paid amount (dollar amount paid by a health plan). Patient characteristics were provided, and per-claim OOP payments were evaluated for each of the 21 therapies in aggregate and stratified by payer type and index therapy.<br />Results: A total of 6094 patients who received at least 1 oral oncolytic therapy were identified. Mean age was 53 years; 54% were women; 77% had a commercial payer; prevalent cancer diagnoses included breast, colorectal, glioblastoma, and lung. Mean OOP payments were highest for dasatinib ($527; median, $36) and lowest for cyclophosphamide ($15; median, $10). Medicare Risk patients had higher mean OOP payments for most therapies compared with commercial, Medicaid, and self-insured patients.<br />Conclusions: Among 21 oral oncolytics, average OOP cost ranged from $15 to >$500. These results confirm previous findings showing OOP payments differing widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient OOP cost will be critical in informing choices.
- Subjects :
- Administration, Oral
Antineoplastic Agents administration & dosage
Antineoplastic Agents therapeutic use
Deductibles and Coinsurance statistics & numerical data
Female
Health Care Costs
Humans
Insurance Claim Review statistics & numerical data
Male
Managed Care Programs economics
Middle Aged
Multivariate Analysis
Neoplasms drug therapy
Retrospective Studies
United States
Antineoplastic Agents economics
Deductibles and Coinsurance economics
Insurance Claim Review economics
Managed Care Programs statistics & numerical data
Neoplasms economics
Subjects
Details
- Language :
- English
- ISSN :
- 1936-2692
- Volume :
- 18
- Issue :
- 5 Spec No. 2
- Database :
- MEDLINE
- Journal :
- The American journal of managed care
- Publication Type :
- Academic Journal
- Accession number :
- 22693982