Accessibility and Affordability of High Priced Drugs in Advanced Non-Small Cell Lung Cancer Public Deposited

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  • March 22, 2019
Creator
  • Chou, Yi-Ting
    • Affiliation: Eshelman School of Pharmacy, Pharmaceutical Sciences Program
Abstract
  • Lung cancer is the leading cause of cancer death in the U.S. It is a disease with poor prognosis that mainly occurring in older population. Treatment options have been increasing for lung cancer recently. However, high out-of-pocket costs is a major concern regarding the use of novel drug treatments, which could impact patient’s choice of treatment and even poorer patient outcomes in the long term. Among all, health insurance is an important modifier of financial burden. The study objectives were to examine the extent of Medicare’s benefit designs for drug treatments and the effect of cost-sharing support on treatment uptake in advanced non-small cell lung cancer (NSCLC). We first used Medicare plan formulary files to evaluate the changes in drug prices and benefit designs for lung cancer medications. We then used the SEER-Medicare databases to examine drug utilization, key factors associate with the use through modified Poisson regression, and the effect of cost-sharing support through low-income subsidy on the timing of treatment initiation in the advanced NSCLC population through multivariable COX proportional hazards regression and propensity score weighting. We observed higher entry prices at FDA approval overtime in Part D advanced NSCLC drugs while considerable price hike was also found in older drugs. In addition, high adoption rates of specialty/top tier and utilization management tools were found among Part D plans and across treatment options. The use of Part D medications has been stable but lower than expected. Particularly, we found that low-income subsidy served as a critical factor for Part D drug use and timely initiation of Part D treatment among the advanced NSCLC population. With current plan benefits and ever-increasing drug prices, concerns over affordability of and accessibility to Part D treatments could continue for advanced NSCLC patients. Patient out-of-pocket costs could particularly present a considerable barrier to timely treatment initiation. In the context of current evolving health care reform, identifying sustainable strategies to improve patient affordability of and equal access to high quality care are needed for the cancer population.
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Advisor
  • Farley, Joel
  • Elston Lafata, Jennifer
  • Dusetzina, Stacie
  • Proctor, Amber
  • Stinchcombe, Thomas
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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