PCN24 TYROSINE KINASE INHIBITORS: REAL WORLD EVIDENCE ABOUT HEALTH OUTCOMES IN A MIDDLE INCOME COUNTRY

Abstract

The high cost of antineoplastic therapies generates unprecedented pressure on the health systems in middle income countries; aditionally, the Knowledge Discovery in Databases allows to extract considerable value to evaluated health outcomes. This study assessed the association between adherence and a specific payment model called PGP (Global Prospective Payment, between insurer and provider). Observational retrospective study. Patients with Chronic Myeloid Leukemia (CML) were identified with ICD-10-C921 diagnoses obtained from 2018 High Cost Account database of the institutional cancer cohort. Positive Philadelphia chromosome patients who took Dasatinib or Nilotinib during 2018 were included (n=66). Imatinib was excluded because this drug is included in the health benefit plan in Colombia. Patients who took 100% of the prescribed medication were considered adherent (Morinsky Scale 4/4). Results were analyzed using SPSS version 24, chi-square independence test was used to determine P-value and bivariate analysis was made using binary logistic regression. Dasatinib arm (n=29, median age 65y; 52% female; 62% private regimen), 50% adherent to therapy. Nilotinib arm (n=37, median age 50y; 43% female; 63% private regimen), 59% adherent to therapy. Regardless payment model and TKI, 55% were adherent and 49% had an optimal molecular response. Patients under the PGP model were 100% adherent and, based on the latest available PCR BCR/ABL (real time) report, 89% had an optimal molecular response according to European Leukemia Net recommendations (both TKIs). Significant association were established between Adherence and PGP model (p<0.004; OR=0,49 IC 95% 0,37-0,64) and between optimal molecular response to both TKIs and GPP model (p<0.001; OR=0,43 IC 95% 0,24-0,95). This study provides contemporary real-world evidence about association between adherence to TKIs, optimal molecular response and a prospective payment model in an institution that provides oncological health services. Ensuring adherence to high-cost therapies in middle-income countries through a payment model, could improve health outcomes.