Presenting Author: Khadijah Khan, CPhT, Walgreen Co., Deerfield, IL
Co-Authors: Francis C. Staskon, PhD, and Laly Havern, PharmD, Walgreen Co., Deerfield, IL; Amy Pfeifer, PharmD, BCPS, CSP, Walgreen Co., Appleton, WI
BACKGROUND: Connected Care Oncology is a patient-centered clinical program that includes a set of 21 unique oral hematologic oncolytic agents for affected oncology patients.
OBJECTIVE: To identify significant associations between a discontinuation adherence metric for the set of Connected Care Oncology hematologic oral oncolytic agents and total medical costs, hospitalizations, and total length of stay (LOS) for inpatients. Research was deemed exempt from HIPAA (Health Insurance Portability and Accountability Act) by Walgreens Advarra Independent Review Board #39505.
METHODS: A retrospective cohort design of patients was used from the MarketScan Commercial Claims and Encounters for 2022. The sample selection required ≥2 fills of targeted medication from the 2022 files with a primary cancer diagnosis code in medical files for 2021 or 2022, and patients must have been continuously enrolled and aged 18 to 64 years. Exclusion criteria were presence of hospice care or organ transplants and those starting medication therapy in the last 45 days of 2022. Discontinuation was indicated by a gap exceeding 1.5 times (previous days’ supply) on consecutive fills. General linear models predicted total medical costs, hospitalizations, and LOS (with gamma or logit links). Predictors included discontinuation, and 12 covariates (including COVID-19 indications, surgeries, Charlson Comorbidity Index comorbidities [less cancer], combination therapy, inpatient and outpatient utilization levels, demographics, and insurance type) and their interaction terms. The economic valuation compared the model predictions by discontinuation status.
RESULTS: A total of 4296 patients in 2022 met sample and model criteria, with 72.3% adherent. Predicted total medical costs significantly increased for nonadherent patients compared with adherent patients ($73,663 per member per year [PMPY]; P<.0001). When considering the additional costs associated with pharmacy adherence, the predicted total medical and pharmacy costs remained increased for nonadherent patients ($19,193 PMPY; P<.46). Compared with adherent patients, odds of hospitalization were significantly increased (odds ratio, 2.22; P<.0001) and LOS was significantly longer for nonadherent patients (4 days; P<.0001). When considering the difference in hospital admissions rate and LOS when admitted, the predicted inpatient medical spend was higher for the nonadherent patients ($22,691 PMPY). Details on all significant model covariates and outcomes as well as economic valuation comparisons are presented in the poster.
CONCLUSION: Being adherent to oral hematologic oncolytics can lead to lower medical costs, odds of hospitalization, and LOS after controlling for many other influences on these outcomes.