According to a study presented at the 2021 ASCO Quality Care Symposium, cost-related prescription nonadherence is associated with higher health care cost responsibility in cancer survivors, especially for those living in rural compared to urban areas.

These findings were presented by Courtney Williams, DrPH, University of Alabama at Birmingham, lead author of this study.

“Little is known about the direct patient costs, which lead to prescription nonadherence among older cancer survivors and if there are potentially differences between those survivors living in rural and urban areas,” said Dr Williams.

This study aimed to quantify patient costs overall and by residence for older cancer survivors who did and did not report cost-related prescription nonadherence.

Data from the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource (SEER-CAHPS) from 2007 to 2015 were used for this study.

Patient cost responsibility data included patients’ deductibles, coinsurance, and copayments, and were summed for all medical care received in the year prior to the survey. Gamma generalized linear models estimated differences in patient cost responsibility. Effect modification was examined through models stratified by urban/rural residence.

A total of 11,829 older adult (median age, 76 years) cancer survivors were included in this study. Overall, 37% of participants were survivors of prostate cancer, 32% breast cancer, 14% colorectal cancer, 10% gynecologic cancer, and 6% lung cancer. Cost-related prescription nonadherence in the prior year was reported in 12% of participants.

Among patients reporting nonadherence, median cost responsibility in the year prior to survey was $1529, and $1123 among patients reporting adherence. Compared to patients reporting adherence, those reporting nonadherence had $656 higher patient cost responsibility in the year prior in the adjusted models, $277 of which went toward outpatient spending.

Between those reporting nonadherence vs those reporting adherence, patients in rural areas experienced small differences in cost responsibility (18% of respondents; β = $341), while those in urban experienced larger differences (82% of respondents; β = $715)

“Compared to those reporting adherence, cost-related prescription nonadherence was associated with higher health care cost responsibility in cancer survivors. Furthermore, prescription adherence decisions may be more cost-sensitive for patients living in rural compared to urban areas,” concluded Dr Williams and colleagues.

“Interventions to address out-of-pocket health care costs, particularly for rural cancer survivors, could aid in increased prescription adherence and subsequent health outcomes,” they added.

Williams C, Davidoff A, Halpern M, et al. Medication nonadherence and patient cost responsibility for rural and urban cancer survivors. Presented at: the 2021 ASCO Quality Care Symposium; September 25-26, 2021; Boston, MA, and virtual; Abstract 4