Economic Cost and Sustainability of Oral Therapies in Precision Oncology

Abstract

PURPOSE: Precision oncology promises improved outcomes but the cost-effectiveness and accessibility of targeted therapies is debatable. We report price change patterns from 2015 to 2019 for several oral anticancer medications for common solid tumor malignancies. METHODS: We collected provider utilization and payment data from the public Medicare Part D database and extracted drug price information for commonly prescribed targeted oral anticancer agents for lung, breast, and prostate cancer. We then calculated median Pearson correlation coefficient values for various drugs (containing more than two data points) within each therapeutic class. We also calculated compound annual growth rates (CAGRs) for medication costs within each class and compared them with the consumer price index (CPI). RESULTS: Our study included six epidermal growth factor receptor inhibitors (EGFRi; one generic), five anaplastic lymphoma kinase inhibitors (ALKi), two B-Raf inhibitors (BRAFi), three hormonal agents (one generic), three cyclin-dependent kinases 4 and 6 inhibitors (CDK4/6i), two poly-ADP-ribose inhibitors (PARPi), and seven antiandrogen agents (two generic). The median (range) Pearson correlation coefficient values for cost of drugs within each therapeutic class were 0.967 (0.915-0.978) for EGFRi, 0.981 (0.966-0.989) for ALKi, 0.996 for BRAFi, 0.994 (0.992-0.999) for CDK4/6i, 0.855 for PARPi, and 0.442 (–0.522 to 0.962) for antiandrogens. Therapies with two or fewer data points (generic erlotinib, dacomitinib, abiraterone, apalutamide, and darolutamide) were excluded. The median CAGRs in costs over the 5-year period were 4.56% (EGFRi), 6.40% (ALKi), 2.58% (BRAFi), 5.48% (hormonal agents), 5.21% (CDK4/6i), 27.29% (PARPi), and 34.8% (antiandrogens). The CPI over 5 years was 2.26%/year, and the average inflation rate was 1.90%/year. CONCLUSION: The median CAGR in costs for modern oral precision-driven cancer therapeutic classes mostly outpaced CPI and the average inflation. Increase in cost within the same class should be weighed against incremental clinical benefit for the patients to ensure that rising costs do not limit access to targeted therapies.

Launch and Post-Launch Prices of Injectable Cancer Drugs in the US: Clinical Benefit, Innovation, Epidemiology, and Competition

“…Prior studies inappropriately evaluated the competitive dynamics of the pharmaceutical market based on a price correlation analysis [ 24 , 29 – 31 , 40 ]. They assumed that drugs of the same class compete within the same market.…”

“…Coherent with previous studies, we examined the cancer drug market within drug classes based on the correlation of prices [ 24 , 29 – 31 , 40 ]. The relationship between nine drug classes with a total of 25 injectable cancer agents was analyzed and visualized using a Pearson correlation matrix.…”

Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs

“…Oral anticancer drugs (OADs) are potentially suitable candidates for redispensing. Previous studies have demonstrated that (1) approximately one-third of patients discontinue OAD treatment early, (2) half of the patients that discontinue treatment have unused OAD packages, and (3) (originator) OADs are very expensive drugs, thus wasting these produces substantial financial losses . With the high and increasing budget implications of OADs, waste reduction appears to be a convenient cost-containment strategy because it does not compromise therapeutic value to patients .…”

“…Previous studies have demonstrated that (1) approximately one-third of patients discontinue OAD treatment early, [14][15][16][17] (2) half of the patients that discontinue treatment have unused OAD packages, 18 and (3) (originator) OADs are very expensive drugs, thus wasting these produces substantial financial losses. 19 With the high and increasing budget implications of OADs, waste reduction appears to be a convenient cost-containment strategy because it does not compromise therapeutic value to patients. 20,21 Redispensing unused OADs appears to be feasible given the substantial quantity and cost of the waste 22 ; however, economic benefits must be elicited to promote uptake as standard practice.…”