Presentation (CTI)

OBJECTIVES: To synthesize the evidence published over the last ten years on the relationship between out-of-pocket (OOP) costs and adherence to oral anticancer (OAM) amongst adult cancer patients in the United States.
METHODS: We conducted a targeted literature review of PubMed for observational studies published from January 2014 to August 2024. We included the search terms “oral,” “cancer,” “adherence,” and “out of pocket.” We excluded studies involving intravenous medications, review articles, studies evaluating adherence during clinical trials, and patients without active cancer. We extracted the following data from the studies: study period, number of patients, cancer type, insurance type, results, OOP amounts, and drugs studied.
RESULTS: We identified 740 articles using our search term. We excluded 713 articles based on the title or abstract because the population was not of interest (n=451), outcomes were not related to the objective (n=173), or incorrect study design (n=89). We included 17 studies after a full-text review of the remainder. The studies evaluated claims data from 2002 to 2018, and the sample sizes ranged from 105 to 38,111 patients. We found studies that evaluated breast cancer (n=9), chronic myeloid leukemia (n=5), multiple myeloma (n=2), metastatic renal cell carcinoma (n=2), non-small cell lung cancer (n=2), and other cancers (n=2). We found studies that used commercial insurance claims (n=7), Medicare claims (n=5), and both (n=5). We found significant effects on adherence when OOP costs were studied in monthly increases of $1 to $2,000. We found studies that supported a negative relationship (aOR up to 3.91) between higher OOP costs and adherence (n=12), and studies that had mixed results (n=3) or non-significant results (n=2).
CONCLUSIONS: We found that higher OOP costs for patients with 11 different cancers had a significant, negative impact on adherence to OAM in increases of $1 to $2,000 per month for Medicare and commercial insurance populations.