Lower Discontinuation Rates on Cycled Oral Antineoplastics Can Lead to Lower Medical Costs, Fewer Hospitalizations

Based on the current pipeline, oral antineoplastic drugs will be the mainstay of cancer treatment in the next few years.¹ This increase in usage has identified a need to improve the quality of oral anticancer medication use, but there are no current standardized quality measures to address it. For this reason, we investigated discontinuation rates for oral oncolytic medications and the impact on outcomes of total medical costs and hospitalizations. Specifically, we examined a reported discontinuation rate for a half-year period to exclude end-of-therapy indications on a limited set of medications.

In our analysis, discontinuations were calculated per year as a gap in medication supply at intervals of 1.5 times the last fill day’s supply (eg, for a 14-day fill, the gap would be > 21 days) in the past 6 months of the year (Figure 1 and Figure 2). The measure was generated from patients using 8 generic products in 6 therapy classes as single therapy. The findings were presented at the National Association of Specialty Pharmacy Annual Meeting & Expo in Orlando, Florida, in September 2022.²

According to our study results, a total of 4872 patients in 2018 met the criteria for sample inclusion, and 1534 of these patients also met the criteria from 2018 to 2019. In 2018, 25.6% of patients had a discontinuation, and from 2018 to 2019, 23.5% of patients had a discontinuation in either year. Discontinuation rates in 2018 were significantly lower within the Northeast region, with greater use of mailorder pharmacy and higher provider ratio. However, the rates significantly increased for new-to-therapy patients and those with hospitalization events.

From 2018 to 2019, total medical costs significantly decreased ($12,757; P < .0006) but significantly increased among those who discontinued in 2018 ($50, 558; P < .0001) and over time ($15, 337; P < .0002). Patients who discontinued in 2019 had higher annual estimated costs ($23,080; P < .002). Odds of hospitalization in 2019 were significantly associated with higher discontinuation in 2019 (odds ratio [OR], 2.32; P < .0001) and inversely associated with longer medication coverage in 2018 (< 61 days: OR, 0.66; > 150 days: OR, 0.51; P < .02).

Increasing use of cycled oral antineoplastic therapies, for which dosages vary per monthly supply, has generated interest in examining a discontinuation metric for adherence. Results from our study show that increased medication adherence on cycled oral antineoplastics can lead to lower medical costs and fewer hospitalization events compared with lower adherence levels. Additionally, these results help validate methodology for discontinuations, especially as organizations such as the Pharmacy Quality Alliance continue their initiatives to create standard quality measures in oncology. This metric can be used for annual reporting requirements by implementing filters to control for possible end of therapy, late medication starts in the given year, and product switching within a therapy class.

References

1. Moreira A, Bernardo C, Ramos C, Aguiar P, Alves da Costa F. National trends in the use of oral chemotherapy over 13 years. Front Pharmacol. 2022;13:909948. doi:10.3389/fphar.2022.909948

2. Staskon F, Kirkham K, Witt E, Havern L. Oral oncolytics: adherence, cost, and utilization. Presented at: National Association of Specialty Pharmacy Annual Meeting & Expo; September 19-22, 2022; Orlando, FL.

About the Authors

Laly Havern, PharmD, MS, BCACP, is the director of specialty health solutions in oncology and fertility at Walgreens.

Francis Staskon, PhD, is a principal analyst in health analytics research and reporting at Walgreens.

Edward Witt, PhD, is a manager in health analytics research and reporting at Walgreens.