Clinical and Social Implications of Cost Sharing for Cancer Drugs

简介(申请人提供)：黄宇宁博士，福克斯大通癌症中心肿瘤内科医生，致力于癌症健康服务研究。她的目标是开发一项多学科研究计划，以了解保险设计对癌症药物使用和临床结果的影响。这一职业发展奖将为实现这一目标提供两个重要步骤。首先，它将允许在公共政策研究、卫生经济学和先进的统计方法方面进行额外的强化指导教育和培训，这将加强候选人之前在流行病学、生物统计学和临床医学方面的严格培训。其次，它将支持开发一个原创的临床研究计划，使用严格的流行病学、计量经济学和调查方法来检查处方药保险覆盖范围对癌症结果的影响。随着新的昂贵的抗癌药物的推出，拥有公共和私人保险的患者面临着更高的自付费用。保险公司和患者之间的费用分担(通过自付和免赔额)传统上被用来控制成本，其基础是预期不必要的医疗保健利用率将会减少。然而，这种预期可能会导致更严重的社会经济差距，因为一些患者可能负担不起高效的癌症治疗。候选人提出了三项补充研究，以解决关于费用分担对癌症结果的影响的重要、尚未回答的问题。项目A是一项基于联合分析的调查，旨在衡量患者如何在不同疗效、毒性和成本的治疗方案中做出决定。项目B在决策分析模型中使用项目A的结果来衡量临床结果对价格和患者偏好的敏感性。这也将使我们能够确定是否有可能通过使用低成本分担来提高对高价值治疗的依从性来改善临床结果。项目C是一个自然的实验，使用保险索赔来衡量保险设计和社会人口因素对接受一种新的昂贵的抗恶心药物和随后结果的影响。这项研究计划将对了解癌症药物使用和临床结果的成本分担的核心问题的联系进行三角测量，并为候选人转变为癌症健康服务研究的独立调查者奠定基础。该项目将对高成本医疗干预措施的融资产生广泛影响，因为它将帮助政策制定者、保险公司和医生了解目前的成本分担模式可能如何导致癌症护理中的社会经济差异。我们的结果可能建议考虑一种新的福利设计，鼓励患者根据相对价值而不是仅根据成本做出决定。

DESCRIPTION (provided by applicant): Dr. Yu-Ning Wong, a Medical Oncologist at Fox Chase Cancer Center is dedicated to a career in cancer health services research. Her goal is to develop a multidisciplinary research program to understand the impact of insurance design on cancer drug utilization and clinical outcomes. This Career Development Award will provide the means to take two important steps towards accomplishing this goal. First, it will allow for additional intensive mentored education and training in public policy research, health economics, and advanced statistical methods that will augment the candidate's previous rigorous training in epidemiology, biostatistics, and clinical medicine. Second, it will support the development of an original clinical research program using rigorous epidemiologic, econometric and survey methods to examine the impact of prescription drug insurance coverage on cancer outcomes. As new costly cancer drugs are introduced, patients with both public and private insurance are facing higher out- of-pocket costs. Cost sharing between insurers and patients (though co-payments and deductibles) has been traditionally used to control costs based on an expectation that unnecessary health care utilization will be reduced. However this expectation may result in worse socioeconomic disparities in care since some patients may be unable to afford highly effective cancer treatments. The candidate proposes three complementary studies to address the important, unanswered questions about the impact of cost sharing on cancer outcomes. Project A is a conjoint analysis-based survey to measure how patients make decisions among treatments of varying efficacy, toxicity and cost. Project B uses the results from Project A in a decision analysis model to measure the sensitivity of clinical outcomes to price and patient preferences. This will also allow us to determine if is possible to improve clinical outcomes by using low cost sharing to increase adherence to high value treatments. Project C is a natural experiment using insurance claims to measure the effect of insurance design and sociodemographic factors on the receipt of a new, expensive anti-nausea medication and subsequent outcomes. This research program will triangulate on the nexus of issues central to the understanding of cost sharing on cancer drug utilization and clinical outcomes and form the foundation for the candidate's transition to an independent investigator in cancer health services research. This project will have broad implications for the financing of high cost medical interventions because it will help policy makers, insurers and physicians understand how current models of cost sharing may contribute to socioeconomic disparities in cancer care. Our results may suggest consideration of a novel benefit design that encourages patients to make decisions based on relative value, rather than cost alone.