Patient cost sharing during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment in ovarian cancer.
Patient cost sharing during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment in ovarian cancer.
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DOI：
10.1016/j.ajog.2021.01.029
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发表时间：
2021-07
影响因子：
9.8
通讯作者：
Meyer LA
中科院分区：
文献类型：
--
作者：
Harrison RF;Fu S;Sun CC;Zhao H;Lu KH;Giordano SH;Meyer LA
越来越多的卵巢癌患者正在接受聚（adp -核糖）聚合酶（PARP）抑制剂的治疗，因为监管机构已经批准这些药物用于各种治疗适应症。然而，PARP抑制剂价格昂贵。当作为维持治疗给予时，这些药物可以使用数月或数年。这些费用中有多少是患者自付的尚不清楚。估计患者在PARP抑制剂治疗期间的自付支出，并表征哪些医疗服务占该支出。对2014-2017年接受奥拉帕尼、尼拉帕尼或鲁卡帕尼治疗的卵巢癌患者样本进行了一项回顾性队列研究。患者的身份来自健康保险索赔数据库MarketScan。收集了PARP抑制剂治疗期间的所有保险索赔。主要结果是患者在PARP抑制剂治疗期间对药物本身的自付支出（共同支付、共同保险和免赔额）。其他感兴趣的结果包括其他医疗保健服务的自付支出、使用其他医疗保健服务的类型和频率、健康计划支出、每月用于医疗保健的患者家庭收入的估计比例，以及患者在PARP抑制剂治疗前的自付支出。我们确定了503例中位年龄为55岁的卵巢癌患者（IQR 50-62）；83%的人在PARP抑制剂治疗期间有自付费用。中位治疗持续时间为124天（IQR 66-240）。PARP抑制剂的平均自付费用为每月305美元（SD $2,275）。平均而言，这占患者每月总自付费用的44.8% （SD 34.8%）。其他医疗保健服务的平均自付费用为每月165美元（769 SD美元）。健康计划在PARP抑制剂上每月平均花费12,661美元（15,668美元），在所有其他医疗保健服务上每月平均花费7,108美元（15,254美元）。诊所就诊、实验室检查和影像学检查的费用分摊占非parp自费支出的大部分。在PARP抑制剂治疗期间，患者每月为所有医疗保健服务支付的平均金额为470美元（SD $2,407），估计为患者每月家庭收入的8.7%。PARP抑制剂治疗前12个月的平均自付费用为3110美元（SD为6987美元）。尽管PARP抑制剂治疗期间使用的其他医疗保健服务的费用分摊总额通常更高，但患者可能面临PARP抑制剂的高额自付费用。这些病人的家庭收入中很大一部分用于医疗保健。卵巢癌患者在PARP抑制剂治疗前和治疗期间的医疗保健费用都很高。卵巢癌患者在PARP抑制剂治疗期间可能会经历沉重的自付费用，因为与药物相关的费用作为其他医疗保健服务的共同支付分担。
More patients with ovarian cancer are being treated with poly (ADP-ribose) polymerase (PARP) inhibitors as regulatory agencies have granted these drugs new approvals for a variety of treatment indications. However, PARP inhibitors are expensive. When given as a maintenance therapy, these drugs may be administered for months or years. How much of this cost patients experience as out-of-pocket spending is unknown. To estimate the out-of-pocket spending patients experience during PARP inhibitor treatment, and to characterize which health care services account for that spending. A retrospective cohort study was performed with a sample of ovarian cancer patients treated in 2014–2017 with olaparib, niraparib, or rucaparib. Patients were identified from MarketScan, a health insurance claims database. All insurance claims during PARP inhibitor treatment were collected. The primary outcome was patients’ out-of-pocket spending (copayment, coinsurance, and deductibles) during PARP inhibitor treatment for the medication itself. Other outcomes of interest included out-of-pocket spending for other health care services, the types and frequency of other health care services used, health plan spending, the estimated proportion of patients’ household income used each month for health care, and patients’ out-of-pocket spending immediately prior to PARP inhibitor treatment. We identified 503 ovarian cancer patients with a median age of 55 years (IQR 50–62); 83% had out-of-pocket spending during PARP inhibitor treatment. Median treatment duration was 124 days (IQR 66–240). Mean out-of-pocket spending for PARP inhibitors was $305 (SD $2,275) per month. On average, this accounted for 44.8% (SD 34.8%) of patients’ overall monthly out-of-pocket spending. Mean out-of-pocket spending for other health care services was $165 (SD $769) per month. Health plans spent, on average, $12,661 (SD $15,668) per month for PARP inhibitors and $7,108 (SD $15,254) per month for all other health care services. Cost-sharing for office visits, laboratory tests, and imaging studies represented the majority of non-PARP out-of-pocket spending. The average amount patients paid for all health care services per month during PARP inhibitor treatment was $470 (SD $2,407), which was estimated to be 8.7% of patients’ monthly household income. Mean out-of-pocket spending in the 12 months prior to PARP inhibitor treatment was $3,110 (SD $6,987). Patients can face high out-of-pocket costs for PARP inhibitors, although the sum of cost-sharing for other healthcare services used during PARP inhibitor treatment is often higher. Spending on health care consumes a large proportion of these patients’ household income. Ovarian cancer patients experience high out-of-pocket costs for health care, both before and during PARP inhibitor treatment. Patients with ovarian cancer may experience burdensome out-of-pocket costs during PARP inhibitor treatment due to medication-related cost-sharing as copayments for other health care services.
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