The financial impact of providing oral and injectable anti-cancer medications at the Dallas Veterans Affairs Medical Center (DVAMC)

Abstract

6146 Background: During the past decade, a number of oral and injectable chemotherapy/molecularly targeted drugs have been approved for use in cancer. These medications are expensive and are often not covered by insurance in the same manner as intravenous chemotherapy. This study sought to determine the number of patients referred to the Hematology/Oncology Section (HOS) of DVAMC solely to obtain their medications and to estimate the financial impact of these referrals on DVAMC. Methods: All new consults received by the HOS at DVAMC from 1/03–11/03 were reviewed. Charts were abstracted for the following information: medication requested, disease, age, and sex. Using the Federal prime vendor price list and a conservative estimate of dose and duration of use, an estimate of the annual cost of providing these medications was made. Results: 1038 new outpatient consults were reviewed. 47 (4.5%) were made solely for the DVAMC to provide medication recommended by an outside oncologist. The median age of this group was 72 years (range 50–86). 23 (89%) were male, 5 (11%) were female. Thalidomide was requested by 9 patients (19% of referrals), hydroxyurea by 6 (13%), gefitinib by 5 (11%), imatinib mesylate by 5 (11%), capecitabine by 4 (9%), erythropoietin by 3 (6%), anagrelide by 3 (6%), anastrozole by 2 (4%), and letrozole by 2 (4%). Octreotide, interferon, temozolamide, cyclophosphamide, melphalan, tretinoin, and danazol were each requested by a single patient. The estimated annual cost to DVAMC of providing these medications was $367,549.07. Given a 2003 budget for outpatient medications at DVAMC of $70,000,000, approximately 0.5% of this annual budget was utilized by only 47 patients. Conclusions: Inadequate insurance coverage of oral and injectable anti-cancer medications had a significant financial impact on DVAMC in 2003. More of these medications will be approved for use in the near future. It is imperative that a better system for insurance coverage be devised to avoid overburdening the already strapped VA system. No significant financial relationships to disclose.