Drug costs: acquisition costs are critical but not the entire story of financial toxicity.
Drug costs: acquisition costs are critical but not the entire story of financial toxicity.
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药品成本：采购成本至关重要，但并不是财务毒性的全部。
DOI：
10.1111/bju.16092
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发表时间：
2023
影响因子：
4.5
通讯作者：
Kaye,DeborahR
中科院分区：
文献类型：
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作者：
Kaye,DeborahR
Benjamin及其同事使用获取和定价数据来确定新批准的治疗转移性尿路上皮癌(MUC)的二线和三线药物的治疗成本[1]。他们发现，根据II期和III期临床试验，接受了每种疗法的中位治疗时间的患者的获得成本/价格如下：enfortomab vedotin(158,477美元)，erdafitinib(136,080美元)和saituzumab Government itecan(90,023美元)。尽管许多新的癌症治疗方法之间的比较有效性通常是未知的，但根据药物选择和临床医生的决策，对患者、保险公司和社会的成本影响可能会有很大的不同。在这项研究中，MUC治疗的各种二线和三线治疗方案的获取成本是不同的。不同治疗方案的不同成本也适用于其他GU恶性肿瘤，如转移性去势耐药前列腺癌[2]。这些价格差异表明，临床医生的决策会给患者、保险公司和社会带来不同的成本影响，并可能导致患者经济负担的差异。然而，在考虑这些数据时，重要的是要记住，采购成本和药品价格往往不同于保险公司代表受益人为药品支付的费用(因此，可能通过更高的保费间接转嫁给患者)；保险公司支付的毛付款往往通过复杂的定价机制隐藏[3]。此外，患者的自付费用不一定与保险公司的付款成正比[2]。
Benjamin and colleagues used acquisition and pricing data to determine treatment costs for newly approved second-and third-line agents for metastatic urothelial carcinoma (mUC)[1]. They found that patients who underwent the median duration of treatment for each therapy based upon Phase II and III clinical trials had the following acquisition costs/prices: enfortumab vedotin ($158,477), erdafitinib ($136,080) and sacituzumab govitecan ($90,023).Although the comparative effectiveness amongst many new cancer treatments is often unknown, the cost implications to patients, insurers, and society can be drastically different based upon drug choice and clinician decision-making. In this study, the acquisition costs for various second-and third-line treatment options for mUC treatment are different. Differing costs across various treatment alternatives also applies to other GU malignancies such as metastatic castrate resistant prostate cancer [2]. These price differences suggest that clinician decision-making leads to varying cost implications for patients, insurers and society and could contribute to differences in patient financial burden. When considering these data, however, it is important to keep in mind that acquisition costs and drug prices are often different from what insurers pay for a drug on a beneficiary’s behalf (and therefore what is likely indirectly passed down to patients through higher premiums); gross payments made by insurers are frequently concealed through complex pricing mechanisms [3]. In addition, patient out-of-pocket payments are not necessarily proportional to insurer payments [2].