Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market.
Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market.
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DOI：
10.1093/jncics/pkab045
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发表时间：
2021-08
影响因子：
4.4
通讯作者：
Yao J
中科院分区：
文献类型：
--
作者：
Shih YT;Xu Y;Zhao H;Schrag D;Yao J
我们的研究估计了美国私人保险成年癌症患者与废弃的基于体重的静脉注射抗肿瘤药物相关的保险费用和患者自付费用 (OOP)。我们通过与索赔数据相关的 2017 年 MarketScan 健康风险评估（纽约州阿蒙克市 IBM 公司）确定了接受基于体重的抗肿瘤药物的患者。利用健康风险评估中的体重信息，我们得出了推荐剂量并计算了废弃药物的百分比。我们应用 β 回归来确定与丢弃百分比相关的因素。为了比较有和没有高免赔额计划的患者，我们采用广义线性模型和两部分模型分别检查保险支付和 OOP 费用。所有统计检验都是双面的。在来自 1970 名患者的 27-350 项针对 58 种基于体重的抗肿瘤药物的索赔中，中位废弃百分比为 9.8%（平均 [SD] = 12.8% [10.5%]）。除了药物和肿瘤类型外，最低体重组患者的丢弃率在统计学上显着较高（5.5% [95% 置信区间 = 4.7% 至 6.4%]；P< .001；体重 <150 lb [68.0 kg] 与 ≥200 lb [90.7 kg]）。 2017 年，私人支付者在废弃的基于体重的抗肿瘤药物上为每位患者花费了 5090 美元，而患者在废弃药物上的平均 OOP 费用为 63 美元。总共有 39.7% 的患者有高免赔额计划。高免赔额计划中废弃药物的调整后平均 OOP 费用在统计上显着较高（95 美元 vs 47 美元；P < .001）。私营保险公司因废弃的基于体重的抗肿瘤药物而承受了巨大的经济负担。尽管对于大多数私人保险癌症患者来说，废弃药物的 OOP 费用并不高，但大约 5% 的人在废弃药物上的花费超过 400 美元。旨在减少单剂量、基于体重的抗肿瘤药物的药物浪费的政策应评估其对支付者和患者的财务后果。
Our study estimated insurance payments and patient out-of-pocket (OOP) expenses associated with discarded weight-based intravenous antineoplastic drugs for privately insured US adult patients with cancer. We identified patients who received weight-based antineoplastic drugs from a 2017 MarketScan health risk assessment (IBM Corp, Armonk, NY) linked to claims data. Using weight information in the health risk assessment, we derived the recommended dose and calculated the percentage of drugs discarded. We applied β-regression to determine factors associated with the discarded percentages. To compare patients with and without high-deductible plans, we employed a generalized linear model and a 2-part model to examine insurance payment and OOP expense, respectively. All statistical tests were 2-sided. Of 27 350 claims for 58 weight-based antineoplastic drugs from 1970 patients, the median discarded percentage was 9.8% (mean [SD] = 12.8% [10.5%]). Aside from drug and tumor type, statistically significantly higher discarded percentages were found for patients in the lowest weight group (5.5% [95% confidence interval = 4.7% to 6.4%]; P < .001; weight <150 lb [68.0 kg] vs ≥200 lb [90.7 kg]). Private payers spent $5090 per patient in 2017 on discarded weight-based antineoplastic drugs, and patients’ mean OOP expense on discarded drugs was $63. In total, 39.7% of patients had high-deductible plans. The adjusted mean OOP expense for discarded drugs was statistically significantly higher for those in high-deductible plans ($95 vs $47; P < .001). Private insurers incurred substantial financial burden from discarded weight-based antineoplastic drugs. Although the OOP expenses of discarded drugs were modest for most privately insured patients with cancer, approximately 5% spent more than $400 on the discarded drugs. Policies designed to reduce drug waste from single-dose, weight-based antineoplastic drugs should evaluate their financial consequences for payers and patients.
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影响因子：
2.1
作者：
Basu, A;Manning, WG;Mullahy, J
通讯作者：
Mullahy, J
影响因子：
1.7
作者：
Smith, Rufus S. V.
通讯作者：
Smith, Rufus S. V.
不可避免的是对门诊化学疗法护理的购买和审理系统的改革：经济学家，现实情况和肿瘤学家的观点。
DOI：
10.14694/edbook_am.2015.35.e75
发表时间：
2015
期刊：
American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting
影响因子：
--
作者：
Polite B;Conti RM;Ward JC
通讯作者：
Ward JC
影响因子：
1.3
作者：
Gilbar, Peter J.;Chambers, Carole R.;Tyler, Timothy G.
通讯作者：
Tyler, Timothy G.
影响因子：
9.7
作者：
Kullgren, Jeffrey T.;Cliff, Betsy Q.;Fagerlin, Angela
通讯作者：
Fagerlin, Angela