Utilization impacts of new oral substitutes for parenteral cancer-related therapies

Amy J. Davidoff, Amer Zeidan, Franklin Hendrick, Bruce C. Stuart, Vu H. Duong, Maria R. Baer, Rahul A. Shenolikar, Steven D. Gore

Research output: Contribution to journalArticle

Abstract

Background: Iron chelation therapy (ICT) is indicated in myelodysplastic syndrome (MDS) patients with transfusion-related iron overload. Deferoxamine, administered by lengthy subcutaneous infusions 5 to 7 days per week, was FDA–approved in 1968, whereas the oral chelator deferasirox was approved in November 2005. Objective: To examine the impact of deferasirox market entry on ICT utilization. Study Design: Observational study of ICT use in a cohort selected from 100% of Medicare beneficiaries with MDS diagnostic codes from 2004 to 2008, enrolled in Medicare Part D, and eligible for ICT based on a history of receipt of 20 units of packed red blood cells. Methods: Cox proportional hazards regression models tested the effect of deferasirox market entry on ICT utilization. Adequacy of therapy dose and duration were compared for oral compared with infused ICT users. A post hoc analysis predicted impacts on ICTrelated spending. Results: Eligible beneficiaries (n = 3843) had a median age of 78 years. Individuals who became ICT eligible after deferasirox market entry were 80% more likely to receive ICT by end of 2008. Deferoxamine and deferasirox doses were adequate in fewer than 10% and about 73% of users, respectively. Treatment duration was longer for deferasirox compared with deferoxamine (median 47 weeks vs 17 weeks). Conclusion: Deferasirox market entry was associated with increased ICT use and more adequate treatment dose and duration. Calculated expenditures for a typical treatment course were $46,142 for deferasirox versus $2761 for deferoxamine, representing a substantial cost increase associated with ICT use.

Original languageEnglish (US)
Pages (from-to)e1-e9
JournalAmerican Journal of Pharmacy Benefits
Volume7
Issue number1
StatePublished - Jan 1 2015

Fingerprint

Chelation Therapy
Second Primary Neoplasms
Iron
Deferoxamine
Myelodysplastic Syndromes
Medicare Part D
Substitute
Cancer
Therapy
Subcutaneous Infusions
Iron Overload
deferasirox
Therapeutics
Chelating Agents
Health Expenditures
Medicare
Proportional Hazards Models
Observational Studies
Erythrocytes

ASJC Scopus subject areas

  • Pharmacology, Toxicology and Pharmaceutics (miscellaneous)
  • Business and International Management
  • Decision Sciences (miscellaneous)

Cite this

Davidoff, A. J., Zeidan, A., Hendrick, F., Stuart, B. C., Duong, V. H., Baer, M. R., ... Gore, S. D. (2015). Utilization impacts of new oral substitutes for parenteral cancer-related therapies. American Journal of Pharmacy Benefits, 7(1), e1-e9.

Utilization impacts of new oral substitutes for parenteral cancer-related therapies. / Davidoff, Amy J.; Zeidan, Amer; Hendrick, Franklin; Stuart, Bruce C.; Duong, Vu H.; Baer, Maria R.; Shenolikar, Rahul A.; Gore, Steven D.

In: American Journal of Pharmacy Benefits, Vol. 7, No. 1, 01.01.2015, p. e1-e9.

Research output: Contribution to journalArticle

Davidoff, AJ, Zeidan, A, Hendrick, F, Stuart, BC, Duong, VH, Baer, MR, Shenolikar, RA & Gore, SD 2015, 'Utilization impacts of new oral substitutes for parenteral cancer-related therapies', American Journal of Pharmacy Benefits, vol. 7, no. 1, pp. e1-e9.
Davidoff AJ, Zeidan A, Hendrick F, Stuart BC, Duong VH, Baer MR et al. Utilization impacts of new oral substitutes for parenteral cancer-related therapies. American Journal of Pharmacy Benefits. 2015 Jan 1;7(1):e1-e9.
Davidoff, Amy J. ; Zeidan, Amer ; Hendrick, Franklin ; Stuart, Bruce C. ; Duong, Vu H. ; Baer, Maria R. ; Shenolikar, Rahul A. ; Gore, Steven D. / Utilization impacts of new oral substitutes for parenteral cancer-related therapies. In: American Journal of Pharmacy Benefits. 2015 ; Vol. 7, No. 1. pp. e1-e9.
@article{1e676440679a4dfea35a1701ac4d5439,
title = "Utilization impacts of new oral substitutes for parenteral cancer-related therapies",
abstract = "Background: Iron chelation therapy (ICT) is indicated in myelodysplastic syndrome (MDS) patients with transfusion-related iron overload. Deferoxamine, administered by lengthy subcutaneous infusions 5 to 7 days per week, was FDA–approved in 1968, whereas the oral chelator deferasirox was approved in November 2005. Objective: To examine the impact of deferasirox market entry on ICT utilization. Study Design: Observational study of ICT use in a cohort selected from 100{\%} of Medicare beneficiaries with MDS diagnostic codes from 2004 to 2008, enrolled in Medicare Part D, and eligible for ICT based on a history of receipt of 20 units of packed red blood cells. Methods: Cox proportional hazards regression models tested the effect of deferasirox market entry on ICT utilization. Adequacy of therapy dose and duration were compared for oral compared with infused ICT users. A post hoc analysis predicted impacts on ICTrelated spending. Results: Eligible beneficiaries (n = 3843) had a median age of 78 years. Individuals who became ICT eligible after deferasirox market entry were 80{\%} more likely to receive ICT by end of 2008. Deferoxamine and deferasirox doses were adequate in fewer than 10{\%} and about 73{\%} of users, respectively. Treatment duration was longer for deferasirox compared with deferoxamine (median 47 weeks vs 17 weeks). Conclusion: Deferasirox market entry was associated with increased ICT use and more adequate treatment dose and duration. Calculated expenditures for a typical treatment course were $46,142 for deferasirox versus $2761 for deferoxamine, representing a substantial cost increase associated with ICT use.",
author = "Davidoff, {Amy J.} and Amer Zeidan and Franklin Hendrick and Stuart, {Bruce C.} and Duong, {Vu H.} and Baer, {Maria R.} and Shenolikar, {Rahul A.} and Gore, {Steven D.}",
year = "2015",
month = "1",
day = "1",
language = "English (US)",
volume = "7",
pages = "e1--e9",
journal = "American Journal of Pharmacy Benefits",
issn = "1945-4481",
publisher = "Managed Care and Healthcare Communications",
number = "1",

}

TY - JOUR

T1 - Utilization impacts of new oral substitutes for parenteral cancer-related therapies

AU - Davidoff, Amy J.

AU - Zeidan, Amer

AU - Hendrick, Franklin

AU - Stuart, Bruce C.

AU - Duong, Vu H.

AU - Baer, Maria R.

AU - Shenolikar, Rahul A.

AU - Gore, Steven D.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Iron chelation therapy (ICT) is indicated in myelodysplastic syndrome (MDS) patients with transfusion-related iron overload. Deferoxamine, administered by lengthy subcutaneous infusions 5 to 7 days per week, was FDA–approved in 1968, whereas the oral chelator deferasirox was approved in November 2005. Objective: To examine the impact of deferasirox market entry on ICT utilization. Study Design: Observational study of ICT use in a cohort selected from 100% of Medicare beneficiaries with MDS diagnostic codes from 2004 to 2008, enrolled in Medicare Part D, and eligible for ICT based on a history of receipt of 20 units of packed red blood cells. Methods: Cox proportional hazards regression models tested the effect of deferasirox market entry on ICT utilization. Adequacy of therapy dose and duration were compared for oral compared with infused ICT users. A post hoc analysis predicted impacts on ICTrelated spending. Results: Eligible beneficiaries (n = 3843) had a median age of 78 years. Individuals who became ICT eligible after deferasirox market entry were 80% more likely to receive ICT by end of 2008. Deferoxamine and deferasirox doses were adequate in fewer than 10% and about 73% of users, respectively. Treatment duration was longer for deferasirox compared with deferoxamine (median 47 weeks vs 17 weeks). Conclusion: Deferasirox market entry was associated with increased ICT use and more adequate treatment dose and duration. Calculated expenditures for a typical treatment course were $46,142 for deferasirox versus $2761 for deferoxamine, representing a substantial cost increase associated with ICT use.

AB - Background: Iron chelation therapy (ICT) is indicated in myelodysplastic syndrome (MDS) patients with transfusion-related iron overload. Deferoxamine, administered by lengthy subcutaneous infusions 5 to 7 days per week, was FDA–approved in 1968, whereas the oral chelator deferasirox was approved in November 2005. Objective: To examine the impact of deferasirox market entry on ICT utilization. Study Design: Observational study of ICT use in a cohort selected from 100% of Medicare beneficiaries with MDS diagnostic codes from 2004 to 2008, enrolled in Medicare Part D, and eligible for ICT based on a history of receipt of 20 units of packed red blood cells. Methods: Cox proportional hazards regression models tested the effect of deferasirox market entry on ICT utilization. Adequacy of therapy dose and duration were compared for oral compared with infused ICT users. A post hoc analysis predicted impacts on ICTrelated spending. Results: Eligible beneficiaries (n = 3843) had a median age of 78 years. Individuals who became ICT eligible after deferasirox market entry were 80% more likely to receive ICT by end of 2008. Deferoxamine and deferasirox doses were adequate in fewer than 10% and about 73% of users, respectively. Treatment duration was longer for deferasirox compared with deferoxamine (median 47 weeks vs 17 weeks). Conclusion: Deferasirox market entry was associated with increased ICT use and more adequate treatment dose and duration. Calculated expenditures for a typical treatment course were $46,142 for deferasirox versus $2761 for deferoxamine, representing a substantial cost increase associated with ICT use.

UR - http://www.scopus.com/inward/record.url?scp=84939444473&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84939444473&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:84939444473

VL - 7

SP - e1-e9

JO - American Journal of Pharmacy Benefits

JF - American Journal of Pharmacy Benefits

SN - 1945-4481

IS - 1

ER -