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Adherance to Aromatase Inhibitors Is Higher With Lower-Cost Drugs | Breast Cancer Arabia
  • Adherance to Aromatase Inhibitors Is Higher With Lower-Cost Drugs

    NEW YORK (Reuters Health) – Adherence rates are lower and discontinuation rates are higher with brand name aromatase inhibitors (AIs) than with the less expensive generic equivalents, according to pharmacy claims data.

    “Knowing the profound benefits of aromatase inhibitors in reducing the risk of breast cancer recurrence, it is surprising to see that small changes in out of pocket costs can interfere with optimal use,” Dr. Dawn L. Hershman from College of Physicians and Surgeons, Columbia University, New York told Reuters Health. “However, knowing that care can be improved when lower cost options are available is encouraging and offers some proof that changing policy can make a difference.”

    Adjuvant oral hormonal therapy reduces breast cancer recurrence by more than 30%. Still, only 40% to 60% of women finish their recommended five-year course.

    Dr. Hershman and colleagues used data from the OptumInsights database to investigate the change in adherence patterns before and after the introduction of generic aromatase inhibitors in 2010. They identified 2815 women on brand name AIs, 1411 on generic AIs, and 1285 who switched from brand name to generic AIs.

    Over a quarter of the women (27.1%) discontinued their therapy early, including 32.6% of women taking brand name AIs and 16.2% of women taking generic AIs.

    Discontinuation increased with increasing monthly copayments, whereas discontinuation rates were lower among women with more comorbidities and age over 75.

    In multivariable logistic regression analysis, generic AI users were 53% more likely to have at least 80% adherence than were brand name AI users, the authors reported October 27 online in the Journal of the National Cancer Institute.

    Adherence decreased with increasing monthly copayments and, like discontinuation, decreased with increased comorbid conditions and increased age.

    Even after adjusting for copayment, discontinuation rates were higher and adherence rates were lower among women taking the brand name AIs.

    “Since previous studies have shown that poor adherence and early discontinuation of hormonal therapy are associated with worse survival, public health efforts, such as the Cancer Treatment Fairness Act, should be directed towards increased drug price transparency, improving access, and reducing out-of-pocket costs for life-saving cancer treatments,” the authors conclude. “This is especially important given the rapid increase of expensive oral cancer therapies.”

    “Unfortunately,” Dr. Hershman said, “it is likely that with the rising cost of cancer care, that the out of pocket costs to patients will increase. The cost of aromatase inhibitors is a small fraction of the cost of some of the newer anticancer therapies so one may expect the effects to be more profound with higher priced drugs. While some of the new policies may help some patients a bit with access to therapy, it is likely that an increasing number of cancer patients will have to think of finances when making decisions about treatments.”

    “I think it is important for physicians to ask patients if they are having any difficulty getting the medications they are prescribed,” she said. “Patients often do not want to admit to having financial difficulty. However there are often patient assistant programs available that can help.”

    J Natl Cancer Inst 2014.

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