The 130th Annual Meeting of APHA

Abstract #46650

Florence K. Tangka, PhD¹, Noelle-Angelique M. Molinari, PhD², Sajal Chattopadhyay, PhD³, and Leonardo Stroud, MD, MPH³. (1) NCCDPDP/Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, MS-K55, 4770 Buford Highway, NE, Atlanta, GA 30341, 770-488-1183, fbt9@cdc.gov, (2) NCCDPHP/ Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, MS-K55, 4770 Buford Highway NE, Atlanta, GA 30341, (3) NCCDPHP/Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS-K55, Atlanta, GA 30341

Context: Breast cancer accounts for nearly one of every three cancers diagnosed and is the second leading cause of cancer attributable death among U.S. women. Various combinations of treatment including surgery, hormonal-, chemo-, and radio-therapy are used to treat breast cancer. Although prescription drugs are important in breast cancer treatment, the costs of these drugs received relatively little attention in previous studies.

Objectives: To estimate drug cost per prescription for treatment of female breast cancer patients and analyze its determinants.

Data source and method: 63,431 pharmaceutical drugs claims records for 6,971 women diagnosed with invasive breast cancer at the local stage (stages I – III, with no lymph node involvement) were selected from Medstat’s Marketscan, a large health insurance claims database of 80 self-insured employers, from 1994 to 1997. Cost equation was estimated using a fixed effects model.

Results: Antiestrogen drugs, mainly Tamoxifen (brand name, Nolvadex), accounted for 72% of all prescribed breast cancer drugs. The average cost per prescription was significantly affected by drug ingredient cost, patient’s age, number of days of drug therapy covered by a prescription, class of drug, nature of pharmacy, some plan types, and certain regions. The elasticities of drug cost with respect to ingredient cost, the patient’s age, and days of drugs supplied were 0.82, 0.09, and 0.06, respectively. Controlling for other variables including days supplied, brand name drugs on average cost $2 more per prescription than generic drugs; chemotherapy cost $5 more than antiestrogen drugs; drugs generally available in commercial pharmacies cost $3 more in healthcare pharmacies compared to chain pharmacies; and prescriptions under basic insurance coverage were $0.60 more expensive while those made under preferred provider organization were $1 less costly than those prescribed under comprehensive plan. Also, compared to North Central region, prescription drugs were $0.88 cheaper on average in the Northeast.

Conclusions: The average drug cost per prescription depends significantly on ingredient cost, patient’s age, class of drug, nature of pharmacy, some types of benefit plans, and certain regions. While factors like patients’ age cannot be controlled, others such as nature of pharmacy and type of benefit plan may provide leverage in the reduction of breast cancer prescription drug costs.

Learning Objectives: At the end of the presentation participants will be able to

• Identify the drugs used in the treatment of a large cohort of privately insured breast cancer patients and estimate costs of these drugs per prescription.
• Analyze the determinants of cost of drugs per prescription.
• Assess the usefulness of the findings in the context of cost containment efforts in the health sector.

Keywords: Breast Cancer, Drugs

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.