Grant Details
Grant Number: |
5R01CA225647-04 Interpret this number |
Primary Investigator: |
Shih, Ya-Chen |
Organization: |
University Of Tx Md Anderson Can Ctr |
Project Title: |
Targeted Oral Anticancer Agents: Patterns of Indicated and Off-Label Use, the Associated Factors, and Economic Implications |
Fiscal Year: |
2022 |
Abstract
PROJECT SUMMARY
Targeted oral anticancer medications (TOAMs) have been the focus of oncology drug development in the past
two decades. Although these novel agents contribute to survival improvement in several cancers and are
convenient to administer, high drug prices have raised concerns on their affordability and possibly low
treatment adherence driven by high out-of-pocket expenses. Current knowledge on the utilization and
adherence of TOAMs is largely built upon studies of patients with chronic myelogenous leukemia. It remains
unclear whether such knowledge is directly transferrable to other cancers, especially those with both oral and
intravenous anticancer medications as viable treatment options.
The specific aims of the study are: (1) to examine the utilization patterns of TOAMs as indicated vs. off-label
use; (2) to estimate the impact of TOAM use on the overall costs of cancer care, costs of non-hormonal
systemic therapies, as well as out-of-pocket payment; (3) to investigate the factors associated with the initiation
of a TOAM and time to treatment initiation; and (4) to explore patterns of treatment switches and
discontinuation and the associated factors among patients who started their systemic therapy with a TOAM.
We will address our research questions using various cohorts of cancer patients extracted from three large
claims databases: the SEER-Medicare, MarketScan, and Health Care Cost Institution data.
We will conduct a series of studies to better understand the role of TOAMs in modern cancer care delivery by
systematically studying the utilization pattern and economic impact of TOAMs as well as factors affecting the
initiation and discontinuation of these novel therapies, paying special attention to financial factors for patients
and providers. The findings from our study will inform patients, clinicians, and policy makers of the extent to
which off-label prescription of TOAM is practiced in the real-world and the long-term economic impact of TOAM
use, and provide critical information to guide reform or re-design of insurance policies to avoid creating
financial disincentive to prescribe or use TOAM. Ultimately, the goal of our research is to improve the
accessibility, affordability, effectiveness, and safety of TOAMs.
Publications
Cancer's Lasting Financial Burden: Evidence from a Longitudinal Assessment.
Authors: Shih Y.T.
, Owsley K.M.
, Nicholas L.H.
, Yabroff K.R.
, Bradley C.
.
Source: Journal of the National Cancer Institute, 2022-03-24; , .
EPub date: 2022-03-24.
PMID: 35325197
Related Citations
Treating the Whole Patient With Cancer: The Critical Importance of Understanding and Addressing the Trajectory of Medical Financial Hardship.
Authors: Yabroff K.R.
, Shih Y.T.
, Bradley C.J.
.
Source: Journal of the National Cancer Institute, 2022-03-08; 114(3), p. 335-337.
PMID: 34981116
Related Citations
A Coordinated Policy Approach to Address Medical Financial Toxicity.
Authors: Bradley C.J.
, Yabroff K.R.
, Shih Y.T.
.
Source: JAMA oncology, 2021-12-01; 7(12), p. 1761-1762.
PMID: 34673882
Related Citations
Sensitivity of Psychosocial Distress Screening to Identify Cancer Patients at Risk for Financial Hardship During Care Delivery.
Authors: Maldonado J.A.
, Fu S.
, Chen Y.S.
, Acquati C.
, Yabroff K.R.
, Banegas M.P.
, Chang S.
, Conti R.M.
, Checka C.M.
, Peterson S.K.
, et al.
.
Source: JCO oncology practice, 2021 12; 17(12), p. e1856-e1865.
EPub date: 2021-05-27.
PMID: 34043452
Related Citations
A look at the gynecologic oncologist workforce - Are we meeting patient demand?
Authors: Ackroyd S.A.
, Shih Y.T.
, Kim B.
, Lee N.K.
, Halpern M.T.
.
Source: Gynecologic oncology, 2021 11; 163(2), p. 229-236.
EPub date: 2021-08-27.
PMID: 34456058
Related Citations
A Systematic Review of Economic and Quality-of-Life Research in Carcinoid Syndrome.
Authors: Pan I.W.
, Halperin D.M.
, Kim B.
, Yao J.C.
, Shih Y.T.
.
Source: PharmacoEconomics, 2021 11; 39(11), p. 1271-1297.
EPub date: 2021-08-11.
PMID: 34378163
Related Citations
Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market.
Authors: Shih Y.T.
, Xu Y.
, Zhao H.
, Schrag D.
, Yao J.
.
Source: JNCI cancer spectrum, 2021 08; 5(4), .
EPub date: 2021-05-18.
PMID: 34350376
Related Citations
Patient-Reported Out-of-Pocket Costs and Financial Toxicity During Early-Phase Oncology Clinical Trials.
Authors: Huey R.W.
, George G.C.
, Phillips P.
, White R.
, Fu S.
, Janku F.
, Karp D.D.
, Naing A.
, Piha-Paul S.
, Subbiah V.
, et al.
.
Source: The oncologist, 2021 07; 26(7), p. 588-596.
EPub date: 2021-04-21.
PMID: 33783054
Related Citations
Time to add screening for financial hardship as a quality measure?
Authors: Bradley C.J.
, Yabroff K.R.
, Zafar S.Y.
, Shih Y.T.
.
Source: CA: a cancer journal for clinicians, 2021 03; 71(2), p. 100-106.
EPub date: 2020-11-23.
PMID: 33226648
Related Citations
State of Physician and Pharmacist Oncology Workforce in the United States in 2019.
Authors: Shih Y.T.
, Kim B.
, Halpern M.T.
.
Source: JCO oncology practice, 2021 01; 17(1), p. e1-e10.
EPub date: 2020-12-03.
PMID: 33270520
Related Citations
Understanding Financial Hardship Among Cancer Survivors in the United States: Strategies for Prevention and Mitigation.
Authors: Yabroff K.R.
, Bradley C.
, Shih Y.T.
.
Source: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2020-02-01; 38(4), p. 292-301.
EPub date: 2019-12-05.
PMID: 31804869
Related Citations
Rising Economic Burden of Renal Cell Carcinoma among Elderly Patients in the USA: Part II-An Updated Analysis of SEER-Medicare Data.
Authors: Shih Y.T.
, Xu Y.
, Chien C.R.
, Kim B.
, Shen Y.
, Li L.
, Geynisman D.M.
.
Source: PharmacoEconomics, 2019 12; 37(12), p. 1495-1507.
PMID: 31286464
Related Citations
Treatment value of second-generation BCR-ABL1 tyrosine kinase inhibitors compared with imatinib to achieve treatment-free remission in patients with chronic myeloid leukaemia: a modelling study.
Authors: Shih Y.T.
, Cortes J.E.
, Kantarjian H.M.
.
Source: The Lancet. Haematology, 2019 Aug; 6(8), p. e398-e408.
EPub date: 2019-06-14.
PMID: 31208943
Related Citations