Skip to main content

Advertisement

SpringerLink
Log in

Association between financial burden and adjuvant hormonal therapy adherence and persistent use for privately insured women aged 18–64 years in BCBS of Texas

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

The objective of this study is to understand an impact of financial burden on the adjuvant hormonal therapy (AHT) adherence and persistence for insured women aged 18–64 with early breast cancer in Texas.

Methods

We conducted a retrospective cohort study using claims data for population insured by Blue Cross Blue Shield of Texas from the year 2008 to 2013. Outcomes include adherence to adjuvant hormonal therapy, which was measured by medication possession ratio and persistence on AHT, which is the duration of time from initiation to discontinuation of therapy. Multivariate logistic regression models with repeated regional-level adjustments were used to explore the odds of AHT adherence. Cox proportional hazards model was conducted to assess time to the first 90+-day gap for persistence and a Kaplan–Meier curve were used to estimate probabilities to calculate the percentages of women who experienced 90+-day gaps in AHT.

Results

Of the 938 women in the cohort, 627 (66.8%) initiated the treatment. By year 1, 66.9% of women were adherent to the therapy, and by year 5, only 29% of those were adherent. The percentage of women with no gap in therapy greater than 90 days was 80.8%. Both higher out-of-pocket costs spent on all prescription drugs except AHT and AHT-specific out-of-pocket costs were negatively associated with adherence to AHT as well as continuing AHT as recommended.

Conclusions

Financial burdens including both non-AHT medication and AHT-specific out-of-pocket costs were significantly associated with adherence and persistence to the therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Yung RL, Hassett MJ, Chen K, Gesten FC, Roohan PJ, Boscoe FP et al (2012) Initiation of adjuvant hormone therapy by medicaid insured women with nonmetastatic breast cancer. J Natl Cancer Inst 14:1102–1111

    Article  Google Scholar 

  2. Owusu C, Buist DSM, Field TS, Lash TL, Thwin SS, Geiger AM et al (2008) Predictors of tamoxifen discontinuation among older women with estrogen receptor—breast cancer. J Clin Oncol 26:549–555

    Article  PubMed  Google Scholar 

  3. Hershman DL, Kushi LH, Shao T, Buono D, Kershenbaum A, Tsai WY et al (2010) Early discontinuation and nonadherence to adjuvant hormonal therapy in a cohort of 8769 early-stage breast cancer patients. J Clin Oncol 28:4120–4128

    Article  PubMed  PubMed Central  Google Scholar 

  4. Vrijens France, Stordeur Sabine, Beirens Koen, Devriese Stephan, Van Eycken Elizabeth, Vlayen Joan (2012) Effect of hospital volume on processes of care and 5-year survival after breast cancer: a population-based study on 25000 women. The Breast 21(3):261–266

    Article  PubMed  Google Scholar 

  5. Measring the Quality of Cancer Care. The National Initiative for Cancer Care Quality (NICCQ). 2006. RAND. www.rand.org as a public service of the RAND Corporation

  6. Aday LA, Begley C, Lairson D, Balkrishnan R (2004) Evaluating the healthcare system: effectiveness, efficiency and equity, 3rd edn. Health Administration Press, Chicago

    Google Scholar 

  7. Partridge AH (2003) Nonadherence to adjuvant tamoxifen therapy in women with primary breast cancer. J Clin Oncol 21(4):602–606. https://doi.org/10.1200/jco.2003.07.071

    Article  PubMed  CAS  Google Scholar 

  8. Nekhlyudov L, Li L, Ross-Degnan D, Wagner AK (2011) Five-year patterns of adjuvant therapy use, persistence, and adherence among insured women with early-stage breast cancer. Breast Cancer Res Treat 130(2):681

    Article  PubMed  CAS  Google Scholar 

  9. Kimmick G, Anderson R, Camacho F, Bhosle M, Hwang W, Balkrishnan R (2009) Adjuvant hormonaltherapy use among insured, low-income women with breast cancer. J Clin Oncol 27(21):3445–3451

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cohen R, Gindi R, Kirzinger W. Financial burden of medical care: early release of estimates from the national health interview survey. http://www.cdc.gov/nchs/data/nhis/earlyrelease/financial_burden_of_medical_care_032012.pdf. Accessed 15 Jan 2014

  11. Goldman DP, Joyce GF, Lawless G, Crown WH, Willey V (2006) Benefit design and specialty drug use. Health Affairs 25(5):1319–1331

    Article  PubMed  Google Scholar 

  12. Farias AJ, Du XL (2016) The association between out-of-pocket costs, race/ethnicity, and adjuvant endocrine therapy adherence among Medicare patients with breast cancer. J Clin Oncol 35(1):86–95

    Article  PubMed  PubMed Central  Google Scholar 

  13. Biggers et al (2016) Medicare D subsidies and racial disparities in persistence and adherence with hormonal therapy. J Clin Oncol 34(36):4398–4404

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nattinger AB, Laud PW, Bajorunaite R, Sparapani RA, Freeman JL (2004) An algorithm for the use of Medicare claims data to identify women with incident breast cancer. Health Serv Res 39(6Pt 1):1733–1749

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cramer JA, Roy A, Burrell A, Fairchild CJ et al (2007) Medication compliance and persistence: terminology and definitions. Int Soc Pharma Outcomes Res (ISPOR) 11(1):44–47

    Google Scholar 

  16. Neugut AI, HIllyer GC, Kushi LH, LAmerato L, Leoce N, Nathanson DS et al (2012) Non-initiation of adjuvant hormonal therapy in women with hormone receptor positive breast cancer: the breast cancer quality of care study (B-QUAL). Breast Cancer Res Treat 134(1):419–428

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA (2006) Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat 99:215–220

    Article  PubMed  Google Scholar 

  18. Sedjo RL, Devine S (2011) Predictors of non-adherence to aromatase inhibitors among commercially insured women with breast cancer. Breast Cancer Research Treat Vol 125:191–200

    Article  CAS  Google Scholar 

  19. Kimmick G, Anderson R, Camacho F, Bhosle M, Hwang W, Balkrishnan R (2009) Adjuvant hormonal therapy use among insured, low-income women with breast cancer. J Clin Oncol 27:3445–3451

    Article  PubMed  PubMed Central  Google Scholar 

  20. Barron TI, Connolly R, Bennett K, Freely J, Kennedy J (2007) Early discontinuation of tamoxifen: a lesson for oncologists. Cancer 109:832–839

    Article  PubMed  CAS  Google Scholar 

  21. Cluse C, Rey D, Huiart L, BenDiane MK, Bouhnik AD, Berenger C et al (2012) Adjuvant endocrine therapy with tamoxifen in young women with breast cancer: determinants of interruptions vary over time. Ann Oncol 23:882–890

    Article  Google Scholar 

  22. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  23. The dartmouth atlas of health care. http://www.dartmouthatlas.org/data/region/

  24. Neugut AI, Subar M, Wilde ET et al (2011) Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol 29(18):2534–2542

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hershman DL, Tsui J, Meyer J et al (2014) The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early-stage breast cancer. J Natl Cancer Inst 106(11):dju319

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Karnon J (2006) Aromatase inhibitors in breast cancer: a review of cost considerations and cost effectiveness. Pharmacoeconomics 24(3):215–232

    Article  PubMed  CAS  Google Scholar 

  27. Doughty JC (2011) When to start an aromatase inhibitor: now or later? J Surg Oncol 103(7):730–738

    Article  PubMed  Google Scholar 

  28. Arimidex, Tamoxifen, Alone or in Combination Trialists’ Group, Buzdar A, Howell A, Cuzick J, Wale C, Distler W, et al (2006) Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: Long-term safety analysis of the ATAC trial. Lancet Oncol 7(8):633–43

  29. Duffy S, Jackson TL, Lansdown M, Philips K, Wells M, Clack G et al (2010) The ATAC adjuvant breast-cancer trial: six-year results of the endometrial subprotocol. J Obstet Gynaecol 30(6):596–604

    Article  PubMed  CAS  Google Scholar 

  30. Goldman DP, Joyce GF, Escarce JJ et al (2004) Pharmacy benefits and the use of drugs by the chronically ill. JAMA 291:2344–2350

    Article  PubMed  CAS  Google Scholar 

  31. Hadji P (2010) Improving compliance and persistence to adjuvant tamoxifen and aromatase inhibitor therapy. Crit Rev Oncol Hematol 73:156–166

    Article  PubMed  Google Scholar 

  32. Hede K (2009) Increase in oral cancer drugs raises thorny issues for oncology practices. J Natl Cancer Inst 101(22):1534–1536

    Article  PubMed  Google Scholar 

  33. Vanchieri C (2005) When will the U.S. flinch at cancer drug prices? J Natl Cancer Inst 97(9):624–626

    Article  PubMed  Google Scholar 

  34. Benson R, Wilson C, Williams MV (1998) Comments on Costs of treating advanced colorectal cancer, Ross et al., Eur J Cancer. 1996;32A:S13–S17. Eur J Cancer 34:593–594

  35. Ruddy K, Mayer E, Partridge A (2009) Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin 59(1):56–66

    Article  PubMed  Google Scholar 

  36. Hershman DL, Shao T, Kushi LH et al (2011) Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat 126:529. https://doi.org/10.1007/s10549-010-1132-4

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX, 77030, USA

    Junghyun Kim

  2. Management Policy & Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler Street, Houston, TX, 77030, USA

    Suja S. Rajan

  3. Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler Street, Houston, TX, 77030, USA

    Xianglin L. Du

  4. Health Services Administration, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD, 20742-2611, USA

    Luisa Franzini

  5. Department Chair, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Sharon H. Giordano

  6. Department Chair, Management Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler Street, Houston, TX, 77030, USA

    Robert O. Morgan

Authors
  1. Junghyun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suja S. Rajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xianglin L. Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luisa Franzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sharon H. Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert O. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Junghyun Kim.

Ethics declarations

Conflict of interest

None.

Appendix

Appendix

See Tables 5, 6 and Figs. 4, 5, 6, 7.

Table 5 Predictors of failure to persist with AHT (60-day duration of gap in therapy)
Full size table
Table 6 Predictors of failure to persist with AHT (180-day duration of gap in therapy)
Full size table
Fig. 4
figure 4

Probability of 60-day AHT persistence by out-of-pocket cost of other medications

Full size image
Fig. 5
figure 5

Probability of 60-day AHT persistence by out-of-pocket cost for AHT

Full size image
Fig. 6
figure 6

Probability of 180-day AHT persistence by out-of-pocket cost of other medications

Full size image
Fig. 7
figure 7

Probability of 180-day AHT persistence by out-of-pocket cost for AHT

Full size image

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J., Rajan, S.S., Du, X.L. et al. Association between financial burden and adjuvant hormonal therapy adherence and persistent use for privately insured women aged 18–64 years in BCBS of Texas. Breast Cancer Res Treat 169, 573–586 (2018). https://doi.org/10.1007/s10549-018-4704-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-018-4704-3

Keywords

Search

Navigation