Oral Chemotherapy Program Improves Adherence and Reduces Medication Wastage and Hospital Admissions

Abstract

Adherence, medication wastage, and reduction in hospital admissions were investigated in a retrospective test-control study design for patients enrolled in the oral chemotherapy cycle management program (CMP), a program that offers clinical support, dose monitoring, and early identification of side effects for patients on select oral chemotherapy. Patients who initiated oral chemotherapy with sorafenib, sunitinib, or erlotinib during June 2008 through December 2009 and who were enrolled in the CMP were included as a test group. Patients who initiated oral chemotherapy with these drugs using Walgreens Specialty Pharmacy during January 2007 through May 2008 and were not part of the CMP were included as control group 1, and patients from a national payor database who initiated therapy with sorafenib, sunitinib, or erlotinib during June 2008 through August 2010 were included as control group 2. Compared with control group 1, patients in the CMP group showed no significant differences with regard to their possession ratios (P > .05), but demonstrated significantly higher persistency rates (P < .05) at the end of 6 months follow-up. For patients in the CMP group who discontinued therapy, approximately 34% could have experienced reduced wastage had they been on a split medication plan. Patients who are monitored closely and able to identify serious side effects early can avoid complications leading to hospitalizations. The study showed potential savings on drug costs because of a split-fill medication plan, and savings from reduced hospitalization associated with timely identification and management of severe side effects. A clinical program, such as CMP, effectively improves adherence and reduces wastage and hospitalizations for oral chemotherapeutic agents, realizing potential cost savings to both payors and patients.

A Systematic Review of Adherence to Oral Antineoplastic Therapies

“…In a total of 12 studies ( [44][45][46][47], treatment monitoring [48], pharmacy-based programs [42,49,50], counseling programs [51,52], prefilled pill boxes [53], and automated voice response systems [54]. Five of these studies were randomized trials, none of which demonstrated significant differences between the intervention and control groups with respect to their primary adherence outcomes [44,45,47,52,54].…”

“…One randomized, three-arm trial did show differences in adherence, favoring the intervention groups, when the investigators conducted a post hoc pooled analysis comparing both interventions to the control group [47]. The remaining investigations included two single-group studies (i.e., a feasibility pilot study [46] and a randomized crossover study [53]) and five investigations of nonrandomized observational cohorts with control groups [42,[48][49][50][51]. Of these investigations, only two nonrandomized cohort studies showed a significant benefit of their respective interventions for adherence to oral antineoplastic therapy relative to their control groups.…”

“…As shown in Table 2, the research team rated the majority of the intervention studies (58.3% [n 5 7 of 12]) to have high riskof bias, primarily because of use of single-group and nonrandomized study designs [42,46,[48][49][50][51]53], lack of power analyses, and/or small samples sizes [42,46,48,49,51,53], as well as missing outcome data [42,46,[48][49][50][51]53], among other factors (supplemental online Appendix 3 provides full criteria and ratings). …”

Administration of Oral Chemotherapy: Results From Three Rounds of the Quality Oncology Practice Initiative

“…4,5 Furthermore, the substantial direct financial cost of oral agents can be increased by the cost of managing complications from adverse effects, drug-drug interactions, and poor adherence. Interventions to monitor adherence have improved outcomes and survival 6 as well as reduced cost 7 ; however, the feasibility of their widespread implementation is unknown.…”

Improving medication adherence in patients with chronic disease using a targeted and tailored approach

“…[4][5][6][7][8][51][52][53][54][55][56][57][58] Medication non-adherence can lead to adverse health outcomes, increased hospitalisations and health care costs. 3,12,18,55,59 The adverse impact of medication non-adherence grows as the burden of chronic diseases increases. 1 This section discusses the prevalence of non-adherence, and the clinical outcomes, hospitalisations and health care expenditure associated with medication non-adherence.…”