Following an educational intervention for Idaho Medicaid patients identified through retrospective DUR, a trial of a migraine prophylactic drug was initiated for approximately one-third of potential candidates.

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Background: It has been estimated that over $8 billion is spent annually on the management of breast cancer in the US. The taxane chemotherapeutic agents are cornerstones in the treatment of breast cancer.Although the solvent-based taxanes, generic paclitaxel (Taxol and others) and docetaxel (Taxotere), have lower drug acquisition costs than nab-paclitaxel (Abraxane), nab-paclitaxel offers potential clinical advantages such as better tumor responses with lower rates of severe neutropenia and infusion-related reactions. In order to evaluate whether taxane choice affects the economic outcomes of metastatic breast cancer (MBC) treatment, we evaluated the total cost of care of a cohort of women with MBC.Objective: To determine if differences exist in the total cost of care in patients receiving taxane-based chemotherapy for MBC. Additionally, a comparison between the taxanes was performed on the use of ancillary medications (for neutropenia, anemia, and nausea and vomiting) and their associated costs. Costs per utilizing patient with MBC per month were calculated and compared.Methods: Women with MBC were identified with ICD-9-CM codes and by their prior use of adjuvant chemotherapeutic regimens. Paid medical claims from the period of January 1, 2006 to December 31, 2007 were captured.The study groups were determined according to the taxane administered to women with MBC. Total medical costs were captured from the date of first taxane administration forward to the end of data availability. Outpatient pharmacy costs were not available. Median total medical costs per patient with MBC per month (PPPM) were adjusted for a variety of variables. Utilization and costs of ancillary medications were captured and adjusted with Tobit models.Results: Over the 24-month period, 2,245 women with MBC were identified. There were 1,035 women in the docetaxel group, 997 received paclitaxel, and 213 received nab-paclitaxel. On average, patients in the nab-paclitaxel groups received more doses (9.6) than either generic paclitaxel (6.0) or docetaxel (4.8). The multivariate analysis was robust, explaining 72% of the variability in total medical costs across the 3 taxane groups. Median PPPM total medical costs for women with MBC were within approximately $800 of each other; docetaxel ($4,042; 95% CI, $3,844 - $4,251) and nab-paclitaxel ($3,997; 95% CI, $3,634 - 4,396) total costs were not different whereas generic paclitaxel was less costly ($3,203; 95% CI, $3,029 - $3,388). Nab-paclitaxel had the lowest utilization and lowest costs associated with colony-stimulating factors (CSF).Erythropoietin stimulating agent (ESA) utilization was not significantly different between the 3 drugs. However, compared with docetaxel, ESA expenditures in patients receiving nab-paclitaxel were significantly lower. Anti-emetic use was highest in the docetaxel group, but costs were not different between the three taxanes.Conclusions: For patients with MBC, differences in total medical costs between the three taxanes were modest. Total medical costs were lowest for patients receiving generic paclitaxel and comparable between docetaxel and nab-paclitaxel. Patients on nab-paclitaxel received more doses than the other taxanes. Nab-paclitaxel was associated with lower utilization and costs for CSF compared with generic paclitaxel and docetaxel. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1076.

158 Background: Taxanes in metastatic breast cancer (mBC) have demonstrated clinical benefits but have different toxicity profiles. This study evaluated differences in time to discontinuation (D/C) between taxanes overall and by specific events associated with D/C (i.e., death, adverse events (AE), subsequent therapy). Methods: Women receiving >1 dose of either paclitaxel (P), docetaxel (D), or nab-paclitaxel (nab-P) between 2006-2009 were identified by ICD-9 codes indicative of mBC from a commercial payer claims database. Logistic regression and Cox-proportional hazards models were used to compare rates of D/C and time to D/C, respectively. Control variables were age, use of prior or concurrent chemo, and comorbidity score. Drug D/C was defined as no taxane administration for 35 days. AE within 35-days after D/C were considered taxane-associated. Death or disenrollment from the insurance plan within 90 days and initiation of subsequent therapy within 60 days after D/C were considered temporally associated with D/C. Results: 4,503 pts with mBC were included (2,599 received D; 1,643 received P, and 261 received nab-P). The most common reason for D/C in all pts was AEs (37.8%), initiation of subsequent therapy (34.4%), and death or disenrollment (8.4%). A higher proportion of pts on D (29.4%) and P (17.5%) had D/C due to neutropenia vs nab-P (6.9%, p<0.001 for both comparisons). A higher proportion of pts on nab-P (12.3%) continued on therapy until death/disenrollment vs D (8.9%, p 0.046) or P (7.1%, p 0.023). Similarly, a higher proportion of pts on nab-P (51.2%) initiated subsequent therapy at D/C of taxane vs D (31%) or P (37.3%; p<0.01 for both comparisons). Median time to D/C was 85 days for each of D and P, and 127 days for nab-P (p<0.05). Median time to D/C associated with AEs, neutropenia, death/disenrollment or subsequent therapy were significantly longer for nab-P compared with D or P (p<0.05). Conclusions: Women treated for mBC stayed on nab-P therapy 50% longer than with other taxanes. This time on therapy advantage also indicated that pts on nab-P were less likely to D/C due to AEs, more likely to stay on therapy, and more likely to be candidates for subsequent therapies.

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