Antiemetic choice based on economic advantage.

Abstract

9018 Background: Some advances in oncology have shown real but small benefits despite vast additional cost. Considering rising costs, strategies have been suggested to encourage patients to select cost effective therapies. The disincentive to choose costly care by using co-pays is often thwarted by Pharma funded co-pay assistance programs. We considered using a “carrot” instead of a “stick”; a cash rebate earned by choosing less costly care. We selected antiemetic therapy as our investigative model, as they do not require a choice that affects survival. Methods: Participants completed a survey that portrayed two antiemetic programs. Program A would have a 60% chance of completely eliminating nausea at a cost of $200 per cycle. Program B would have 80% efficacy with a cost of $800. If A was ineffective the patient could switch to B at any time. Both were described as covered by insurance; however, if program A was selected, the patient would receive half of the savings, a $300 rebate per cycle. Results: 162 patients were evaluated, half received prior chemotherapy. Most were female (79.5%) and had cancer (74.5%). More patients chose program A than program B (58.3% versus 41.6%). Neither having had cancer nor previous receipt of chemotherapy significantly affected program selection (p=1.0 and p=0.52, respectively). Within the cohort who had previously received chemotherapy, 63% of patients who had mild or no nausea chose program A compared to 38% of patients who had moderate to severe nausea (p=0.033). We were greatly surprised that 38% of patients who had trouble with prior nausea still chose the less effective program. If all patients received 6 cycles of program B, it would cost $777,600. By giving the patients a choice and reassigning the 40% of patients whose nausea was ineffectively controlled by program A to program B after one cycle, the cost dropped to $556,820. A $220,780 (28.4%) cost savings without access limitation, half going to the patients and half saved by the payers. Conclusions: We demonstrate that a model of shared cost savings utilizing incentives such as cash rebates can potentially decrease the high cost of some pharmaceuticals while maintaining free patient access. We intend to look further into this by investigating patient choice of expensive, low activity therapy.