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- Title
The Change From Brand-Name to Generic Aromatase Inhibitors and Hormone Therapy Adherence for Early-Stage Breast Cancer.
- Authors
Hershman, Dawn L.; Tsui, Jennifer; Meyer, Jay; Glied, Sherry; Hillyer, Grace Clarke; Wright, Jason D.; Neugut, Alfred I.
- Abstract
Background Nonadherence to hormonal therapy is common and is associated with increased copayment amount. We investigated the change in adherence after the introduction of generic aromatase inhibitors (Als) in 2010. Methods Using deidentified pharmacy and claims data from OptumInsight, we identified women older than 50 years on brand-name Als (BAIs) and/or generic Als (GAIs) for early breast cancer between January 1, 2007 and December 31, 2012. Clinical, demographic, and financial variables were evaluated. Adherence was defined as a medication possession ratio (MPR) 80% or greater. Results We identified 5511 women, 2815 (51.1%) on BAI, 1411 (25.6%) on GAI, and 1285 (23.3%) who switched from BAI to GAI. The median 30-day copayment was higher for BAI ($33.3) than for GAI ($9.04). In a multivariable Cox-proportional hazard analysis, women who took GAI were less likely to discontinue therapy (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.57 to 0.84) compared with BAI. Discontinuation was positively associated with a higher monthly copayment of $15 to $30 (HR = 1.21, 95% CI = 1.01 to 1.44) and more than $30 (HR = 1.49, 95% CI = 1.23 to 1.80) compared with less than $15. In a multivariable logistic regression analysis, adherence (medication possession ratio > 80%) was positively associated with GAI use (odds ratio = 1.53, 95% CI = 1.22 to 1.91) compared with BAI and inversely associated with increased monthly copayment. In addition, adherence was associated with a high annual income of more than $100k/year (odds ratio = 1.58, 95% CI = 1.17 to 2.11). Conclusions Higher prescription copayment amount was associated with nonadherence and discontinuation of Als. After controlling for copayment, discontinuation was higher and adherence was lower with Brand Als. Because nonadherence is associated with worse survival, efforts should be directed towards reducing out-of-pocket costs for these life-saving medications.
- Subjects
BREAST cancer treatment; HORMONE therapy; AROMATASE inhibitors; PATIENT compliance; CANCER treatment; THERAPEUTICS
- Publication
JNCI: Journal of the National Cancer Institute, 2014, Vol 106, Issue 11, p1
- ISSN
0027-8874
- Publication type
Article
- DOI
10.1093/jnci/dju319