Dr. Yu-Ning Wong, a Medical Oncologist at Fox Chase Cancer Center is dedicated to a career in cancer health services research. Her goal is to develop a multidisciplinary research program to understand the impact of insurance design on cancer drug utilization and clinical outcomes. This Career Development Award will provide the means to take two important steps towards accomplishing this goal. First, it will allow for additional intensive mentored education and training in public policy research, health economics, and advanced statistical methods that will augment the candidate's previous rigorous training in epidemiology, biostatistics, and clinical medicine. Second, it will support the development of an original clinical research program using rigorous epidemiologic, econometric and survey methods to examine the impact of prescription drug insurance coverage on cancer outcomes. As new costly cancer drugs are introduced, patients with both public and private insurance are facing higher out- of-pocket costs. Cost sharing between insurers and patients (though co-payments and deductibles) has been traditionally used to control costs based on an expectation that unnecessary health care utilization will be reduced. However this expectation may result in worse socioeconomic disparities in care since some patients may be unable to afford highly effective cancer treatments. The candidate proposes three complementary studies to address the important, unanswered questions about the impact of cost sharing on cancer outcomes. Project A is a conjoint analysis-based survey to measure how patients make decisions among treatments of varying efficacy, toxicity and cost. Project B uses the results from Project A in a decision analysis model to measure the sensitivity of clinical outcomes to price and patient preferences. This will also allow us to determine if is possible to improve clinical outcomes by using low cost sharing to increase adherence to high value treatments. Project C is a natural experiment using insurance claims to measure the effect of insurance design and sociodemographic factors on the receipt of a new, expensive anti-nausea medication and subsequent outcomes. This research program will triangulate on the nexus of issues central to the understanding of cost sharing on cancer drug utilization and clinical outcomes and form the foundation for the candidate's transition to an independent investigator in cancer health services research. This project will have broad implications for the financing of high cost medical interventions because it will help policy makers, insurers and physicians understand how current models of cost sharing may contribute to socioeconomic disparities in cancer care. Our results may suggest consideration of a novel benefit design that encourages patients to make decisions based on relative value, rather than cost alone.
