: The high costs associated with several innovative cancer therapies, most notably monoclonal antibodies (mAbs), have raised a concern that even among cancer patients with insurance, mAbs may be financially unaffordable due to the associated high out-of-pocket payment. Such high costs create a vulnerable group of cancer patients known as the """"""""under-insured."""""""" The objectives of our study are to use claims data to examine the diffusion of innovative monoclonal antibody agents among cancer patients younger than 65 years who have private insurance;to explore whether underinsurance may constitute a barrier to the access of these novel therapies;and to determine their impact on the costs of cancer care. The study has five specific aims: (1) to describe the trend of mAb use among non-elderly cancer patients with private insurance;(2) to examine whether mAb utilization patterns differ by patient characteristics and/or insurance generosity in the types of cancer with approved indication for mAb use;(3) to estimate the impact of mAbs on the costs of cancer care and cost increases over time in the types of cancer with approved indication for mAb use;(4) to determine factors associated with off-label mAb use;(5) to estimate the overall costs of cancer care and cost increases over time and to ascertain the associated cost drivers. For each study aim, appropriate econometric methods will be applied to analyze factors associated with mAb use, and cancer treatment costs. Separate analyses will be performed for all cancers, and for each of the three cancer sites that are most likely to be treated with mAbs: non-Hodgkin's lymphoma, colorectal cancer, and breast cancer. As immunotherapy, in particular, mAbs, becomes increasingly important in cancer care, this study will inform policymakers of the diffusion of recent therapeutic innovations among cancer patients and the impact of innovative agents such as mAbs on the costs of cancer care. This information will help project the future costs of cancer. Findings from this study will also alert policymakers to the subgroups of patients who may not benefit from innovative agents such as mAbs due to access barriers.

Public Health Relevance

An increasing number of cancer patients have raised concerns about the issue of underinsurance for a number of recently approved cancer therapies, especially a class of drugs known as monoclonal antibodies (mAbs). These drugs have lead to substantial improvements in patient survival, but are associated with high costs. This study examines the utilization pattern of mAbs and the impact of these novel therapies on cancer costs. This study also explores whether underinsurance might create an access barrier for the use of mAbs among non-elderly cancer patients with private health insurance.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
7R01HS018535-03
Application #
8115138
Study Section
Health Systems Research (HSR)
Program Officer
Hagan, Michael
Project Start
2009-09-30
Project End
2013-07-31
Budget Start
2011-09-01
Budget End
2012-07-31
Support Year
3
Fiscal Year
2011
Total Cost
Indirect Cost
Name
University of Chicago
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
005421136
City
Chicago
State
IL
Country
United States
Zip Code
60637
Smieliauskas, Fabrice; Sharma, Hari; Hurley, Connor et al. (2018) State insurance mandates and off-label use of chemotherapy. Health Econ 27:e55-e70
Shen, Chan; Tina Shih, Ya-Chen (2016) Therapeutic substitutions in the midst of new technology diffusion: The case of treatment for localized prostate cancer. Soc Sci Med 151:110-20
Geynisman, Daniel M; Hu, Jim C; Liu, Lei et al. (2015) Treatment patterns and costs for metastatic renal cell carcinoma patients with private insurance in the United States. Clin Genitourin Cancer 13:e93-100
Shih, Ya-Chen Tina; Smieliauskas, Fabrice; Geynisman, Daniel M et al. (2015) Trends in the Cost and Use of Targeted Cancer Therapies for the Privately Insured Nonelderly: 2001 to 2011. J Clin Oncol 33:2190-6
Carter, Stacey C; Lipsitz, Stuart; Shih, Ya-Chen T et al. (2014) Population-based determinants of radical prostatectomy operative time. BJU Int 113:E112-8
Shih, Ya-Chen Tina; Xu, Ying; Dong, Wenli et al. (2014) First do no harm: population-based study shows non-evidence-based trastuzumab prescription may harm elderly women with breast cancer. Breast Cancer Res Treat 144:417-25
de Souza, Jonas A; Santana, Iuri A; de Castro Jr, Gilberto et al. (2014) Economic analyses in squamous cell carcinoma of the head and neck: a review of the literature from a clinical perspective. Int J Radiat Oncol Biol Phys 89:989-996
Geynisman, Daniel M; Chien, Chun-Ru; Smieliauskas, Fabrice et al. (2014) Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review. Hum Vaccin Immunother 10:3415-24
Jagsi, Reshma; Bekelman, Justin E; Chen, Aileen et al. (2014) Considerations for observational research using large data sets in radiation oncology. Int J Radiat Oncol Biol Phys 90:11-24
Smieliauskas, Fabrice; MacMahon, Heber; Salgia, Ravi et al. (2014) Geographic variation in radiologist capacity and widespread implementation of lung cancer CT screening. J Med Screen 21:207-15

Showing the most recent 10 out of 23 publications