Researchers at the 2021 ASCO Care Quality Symposium presented results from a study examining the association between out-of-pocket costs and prescription adherence among older adult cancer survivors and found that increased intervention may be beneficial, particularly for patients in rural areas.

Using data from the Surveillance, Epidemiology, and End Results Program; Medicare claims; and 2007-2015 Consumer Assessment of Healthcare Providers and Systems Survey (SEER-CAHPS) data, study authors extrapolated metrics on cost-related prescription nonadherence over 6 months. Deductible, coinsurance, and copayment costs were combined for total patient cost responsibility for the year prior to the survey.

The authors noted, “Differences in patient cost responsibility by cost-related adherence was estimated using gamma generalized linear models adjusted for patient age, race, sex, education, dual Medicaid enrollment status, residence, comorbidity count, cancer type, stage, and phase of care.”

A total of 11,829 older adult cancer survivors with a median age of 76 years were included in the final data set—prostate (37%), breast (32%), colorectal (14%), gynecologic (10%), and lung (6%). Twelve percent of included older adults reported any cost-related prescription nonadherence in the prior year.

Results of the study show that prevalence of cost-related nonadherence was similar by patient characteristics.

In the year prior to the survey, median cost responsibility was $1529 (IQR $744-$2959) for patients reporting nonadherence and $1123 (IQR $572-$2362) for those reporting adherence. Nonadherence patients in adjusted models reported $656 higher patient cost responsibility in the year prior (95% CI $564-$760) compared to those who reported adherence. Nearly half of the difference in cost was outpatient spending (β=$277, 95% CI $210-$359).

“Differences in cost responsibility for patients reporting nonadherence compared to adherence were smaller for patients residing in rural areas (18% of respondents; β=$341, 95% CI $177-$564) compared to those residing in urban areas (82% of respondents; β=$715, 95% CI $613-$830),” found researchers.

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

Reference:
Williams C, Davidoff AJ, Halpern MT, et al. Medication nonadherence and patient cost responsibility for rural and urban cancer survivors. J Clin Oncol. 2021;39 (suppl 28; abstr 4). doi:10.1200/JCO.2020.39.28_suppl.004