Delays in Acquisition of Oral Antineoplastic Agents

项目总结 在过去的几年里，口服抗癌药物的扩张速度加快。这些药物是 价格昂贵，费用高达10,000美元/月。为了抵消不断上涨的药品成本，药房福利计划 提高了共同支付费率、免赔额和增加了预授权。我们建议将障碍定义为 启动和不坚持使用价格高得多的抗癌药物以及获得 比其他癌症和非癌症疗法更复杂。我们建议进行一项前瞻性队列研究 在服用非荷尔蒙口服抗肿瘤药物的不同癌症患者中，确定 收购、启动和首次处方续订的障碍，我们将就以下问题进行半结构化访谈 30名参与者的子集。我们假设，收购过程中不断增加的成本和随后的复杂性 与口服药物相关的结果导致延迟和获得障碍，因为 练习一下。我们的具体目标是(1)确定与不开始口服有关的比率和因素 在750名社会经济、种族和人种不同的患者中使用抗肿瘤药物 口腔癌症治疗。(2)确定开始抗肿瘤治疗的时间(天)和影响因素 更长的入门时间。(3)研究早期停用口服抗肿瘤药物的相关因素。 天)在那些发起者中。(4)探讨患者对药物获取过程的感知。这个 这项提案的目标是定义和描述这些新的昂贵口腔疗法的使用范围，如 以及确定与启动和早期延误有关的人力成本和保险相关因素 停产。我们将确定财务因素在多大程度上造成使用差异。结果 将为政策提供信息，并协助设计干预措施，以提高口服药物的质量和安全性 在肿瘤护理中使用。

PROJECT SUMMARY Over the past few years there has been an accelerating expansion of oral anticancer drugs. These drugs are expensive and cost up to $10,000/month. To counteract increasing medication costs, pharmacy benefit plans have increased copayment rates, deductibles and increased preauthorization. We propose to define barriers to initiation and non-adherence to anticancer medications that are considerably more expensive and the acquisition is more complex that other cancer and non-cancer therapies. We propose conduct a prospective cohort study among a diverse population of cancer patients prescribed non-hormonal oral antineoplastic agents, to define barriers to acquisition, initiation and first prescription renewal and we will conduct semi-structured interviews on a subset of 30 participants. We hypothesize that the increasing costs and subsequent complexities in acquisition associated with oral medications results in delays and barriers to access due to the administrative burden on the practice. Our specific aims are (1) to determine the rate and factors associated with non-initiation of oral antineoplastic agents in a socioeconomically, racially and ethnically diverse cohort of 750 patients prescribed oral cancer therapy. (2) To define the time (days) to initiation of antineoplastic treatment and factors contributing to longer initiation time. (3) To examine factors related to early discontinuation of oral antineoplastic agents (<90 days) among those who initiate. (4) To explore patient perceptions on the medication acquisition process. The goal of this proposal is to define and characterize the extent of use of these new expensive oral therapies, as well as to determine human costs and insurance related factors associated with delays in initiation and early discontinuation. We will determine the extent to which financial factors contribute to disparities in use. Results will inform policies and assist with the design of interventions to improve the quality and safety of oral medication use in oncology care.