Expensive Cancer Drugs Research Articles

Combatting the rising costs of cancer drugs; interventions from a university hospital's perspective.

Rapid increase in cost continues to have negative impact on patients' accessibility to life-changing anticancer medications. Moreover, the rising cost does not equate to similar increase in medication effectiveness. We recognise our responsibility as a university hospital to tackle this imbalance and strive to provide high quality, sustainable, affordable and accessible care. An active approach in cost containment of expensive and innovative cancer drugs was adopted in our organisation to safeguard accessibility and improve quality of life for patients. In this article, we described four inverventions: 1) identify right patient and minimise overtreatment, 2) in-house medicine production for selected indications, 3) minimise medicine spillages and 4) effective procurement strategies. We call on other hospitals to take action and, favourably, to collaborate on a European level. Together, we will safeguard the current and future care of our patients.

For Whom the Price Escalates: High Price and Uncertain Value of Cancer Drugs.

The price of cancer drugs has skyrocketed, yet it is not clear whether their value is commensurate with their price. More cancer drugs are approved under expedited review, which considers less rigorous clinical evidence, yet only 20% of them show an overall survival gain in the confirmatory trial. Moreover, clinical data are often generated based on small, single-arm studies with surrogate outcomes, challenging economic evaluation. With their high price and uncertain (marginal) clinical value, cancer drugs are frequently rejected by health technology assessment (HTA) bodies. Therefore, agencies, including the UK’s National Institute for Health and Care Excellence (NICE), have adopted cancer drug funds (CDF) or risk-sharing schemes to provide extra access for expensive cancer drugs which fail to meet NICE’s cost effectiveness threshold. With rising pricing and fewer new cancer medications with novel mechanisms of action, it is unclear if newly marketed cancer therapies address unmet clinical needs or whether we are paying too much. Transparency, equity, innovativeness, and sustainability are all harmed by a “special” approach for cancer medications. If early access is allowed, confirmatory trials within a certain time frame and economic evaluation should be conducted, and label changes or disinvestment should be carried out based on those evaluations.

Reframing cancer: challenging the discourse on cancer and cancer drugs\u2014a Norwegian perspective

BackgroundAs the range of therapeutic options in the field of oncology increases, so too does the strain on health care budgets. The imbalance between what is medically possible and financially feasible is frequently rendered as an issue of tragic choices, giving rise to public controversies around health care rationing.Main bodyWe analyse the Norwegian media discourse on expensive cancer drugs and identify four underlying premises: (1) Cancer drugs are de facto expensive, and one does not and should not question why. (2) Cancer drugs have an indubitable efficacy. (3) Any lifetime gained for a cancer patient is an absolute good, and (4) cancer patients and doctors own the truth about cancer. Applying a principle-based approach, we argue that these premises should be challenged on moral grounds. Within the Norwegian public discourse, however, the premises largely remain unchallenged due to what we find to be unjustified claims of moral superiority. We therefore explore alternative framings of the issue of expensive cancer drugs and discuss their potential to escape the predicament of tragic choices.ConclusionsIn a media discourse that has seemingly stagnated, awareness of the framings within it is necessary in order to challenge the current tragic choices predicament the discourse finds itself in. In order to allow for a discourse not solely concerned with the issue of tragic choices, the premises that underlie it must be subjected to critical examination. As the field of oncology advances rapidly, we depend on a discussion of its opportunities and challenges that is meaningful, and that soberly addresses the future of cancer care—both its potential and its limits.

Association of Supporting Trial Evidence and Reimbursement for Off-Label Use of Cancer Drugs

In many health systems, access to off-label drug use is controlled through reimbursement restrictions by health insurers, especially for expensive cancer drugs. To determine whether evidence from randomized clinical trials is associated with reimbursement decisions for requested off-label use of anticancer drugs in the Swiss health system. This cross-sectional study used reimbursement requests from routinely collected health records of 5809 patients with drug treatment for cancer between January 2015 and July 2018 in 3 major cancer centers, covering cancer care of approximately 5% of the Swiss population, to identify off-label drug use. For each off-label use indication with 3 or more requests, randomized clinical trial evidence on treatment benefits was systematically identified for overall survival (OS) or progression-free survival (PFS). Data were analyzed from August 2018 to December 2020. Available randomized clinical trial evidence on benefits for OS or PFS for requested off-label use indications. The main outcome was the association between evidence for treatment benefit (expressed as improved OS or PFS) and reimbursement in multivariable regression models. Among 3046 patients with cancer, 695 off-label use reimbursement requests in 303 different indications were made for 598 patients (median [interquartile range] age, 64 [53-73] years; 420 [60%] men). Off-label use was intended as first-line treatment in 311 requests (45%). Reimbursement was accepted in 446 requests (64%). For 71 indications, including 431 requests for 376 patients, there were 3 or more requests. Of these, 246 requests (57%) had no supporting evidence for OS or PFS benefit. Reimbursement was granted in 162 of 246 requests without supporting evidence (66%). Of 117 requests supported by OS benefit, 79 (67%) were reimbursed, and of 68 requests supported by PFS benefit alone, 54 (79%) were reimbursed. Evidence of OS benefit from randomized clinical trials was not associated with a higher chance of reimbursement (odds ratio, 0.76, 95% CI, 0.45-1.27). These findings suggest that in a health care system enabling access to off-label use, it was frequently intended as a first-line treatment in cancer care. Availability of randomized clinical trial evidence showing survival benefit was not associated with reimbursement decisions for off-label anticancer drug treatment in Switzerland. A transparent process with criteria considering clinical evidence is needed for evidence-based reimbursement decisions to ensure fair access to cancer treatments.

Cost-effectiveness of cancer drugs: Comparative analysis of the United States and England.

BackgroundEngland's National Institute for Health and Care Excellence (NICE) and the US’ Institute for Clinical and Economic Review (ICER) both conduct cost-effectiveness evaluations for new cancer drugs to help payers make drug coverage decisions. However, NICE and ICER assessments have been noted to reach different conclusions. We aim to better understand the degree to which their recommendations diverge and what drives these apparent differences.MethodsWe compared the methods and results of publicly available cost-effectiveness evaluations performed by ICER and NICE of similarly assessed cancer drugs. Assessments were compared based on incremental cost-effectiveness ratio, comparator treatment, price, recommendation, and the design of the economic evaluation.FindingsAmong 11 commonly assessed cancer drugs, ICER and NICE were in concordance for 7 evaluations and in discordance on the cost-effectiveness and coverage decisions for 4 drugs. Most new cancer drugs were not cost-effective in either the US (7/11) or England (7/11). Furthermore, NICE's capacity to negotiate price discounts and access schemes result in much lower cost per QALY valuations and more favourable recommendations than those of ICER for similarly assessed cancer drugs.InterpretationsNICE and ICER employ similar health technology assessment (HTA) methodologies and were aligned with most recommendations, finding that many new and expensive cancer drugs are cost ineffective. Growing use of ICER assessments will continue to send stronger price signals to manufacturers that cancer drugs with low value for money will be viewed less favourably by private insurers. NICE provides an important reminder of how much lower other countries pay for drugs when comparative effectiveness and value-based pricing are integrated into public drug coverage decisions.

Use of High-Cost Cancer Treatments in Academic and Nonacademic Practice.

Academic physicians, such as those affiliated with National Cancer Institute (NCI)-designated Comprehensive Cancer Centers, may have different practice patterns regarding the use of high-cost cancer drugs than nonacademic physicians. For this cohort study, we linked cancer registry, administrative, and demographic data for patients with newly diagnosed cancer in North Carolina from 2004 to 2011. We selected cancer types with multiple U.S. Food and Drug Administration-approved, National Comprehensive Cancer Network-recommended treatment options and large differences in reimbursement between higher-priced and lower-priced options (stage IV colorectal, stage IV lung, and stage II-IV head-and-neck cancers). We assessed whether provider's practice setting-NCI-designated Comprehensive Cancer Center ("NCI") versus other location ("non-NCI")-was associated with use of higher-cost treatment options. We used inverse probability of exposure weighting to control for patient characteristics. Of 800 eligible patients, 79.6% were treated in non-NCI settings. Patients treated in non-NCI settings were more likely to receive high-cost treatment than patients treated in NCI settings (36.0% vs. 23.2%), with an unadjusted prevalence difference of 12.7% (95% confidence interval [CI], 5.1%-20.0%). After controlling for potential confounding factors, non-NCI patients remained more likely to receive high-cost treatment, although the strength of association was attenuated (adjusted prevalence difference, 9.6%; 95% CI -0.1%-18.7%). Exploratory analyses suggested potential heterogeneity across cancer type and insurance status. Use of higher-cost cancer treatments may be more common in non-NCI than NCI settings. This may reflect differential implementation of clinical evidence, local practice variation, or possibly a response to the reimbursement incentives presented by chemotherapy billing. Oncology care delivery and practice patterns may vary between care settings. By comparing otherwise similar patients treated in National Cancer Institute (NCI)-designated Comprehensive Cancer Centers with those treated elsewhere, this study suggests that patients may be more likely to receive treatment with certain expensive cancer drugs if treated in the non-NCI setting. These practice differences may result in differences in patient costs and outcomes as a result of where they receive treatment.

Using blockchain technology to recycle cancer drugs.

Two startup organisations that are committed to recycling expensive cancer drugs for re-use have been chosen by the US Food and Drug Administration (FDA) to form part of a consortium for a drug supply chain pilot project.

Who should receive expensive cancer drugs?

Who should receive expensive cancer drugs?

Establishing Cancer Information Service in Ghana

Background: African Cancer Organization (ACO) seeks to establish a Cancer Information Service (CIS) Centre in Accra, Ghana to offer information about cancer prevention to the general public and businesses. The whole idea is to promote awareness of cancer and early detection through culturally sensitive and linguistically appropriate cancer information and education programs. The project will navigate people to appropriate facilities for screening, further diagnosis, management and support. This we believe will help prevent people from getting exposed to avoidable cancer risk factors and also help downstage cancers by early-detecting the disease at stages where cure is often possible, which will ultimately help avert the currently prevailing high incidence of cancers in Ghana. Aim: The goal of the project is to ensure that everyone living in Ghana who is eligible has access easy to free cancer information service. The project will establish the needed infrastructure and also build capacity of personnel required to provide cancer information service to the general public and businesses. Methodology: Trained cancer information specialists will provide a one-on-one interaction by telephone, e-mail, instant messaging, social media, in-person visit or on-site business visit. The service will be free and confidential. The project involves setting up an office, distribution of information, education and communication (IEC) materials to educate businesses and the general public about cancer, its prevention, risk factors associated with the disease, sign and symptoms of cancer, cancer diagnosis, treated, management and support systems available. ACO CIS, tailored to the socioeconomic and cultural context, is to ensure that cancer information is available to everyone who is eligible. Conclusion: There is solid evidence that making cancer information available and diagnosing it at an early stage will reduce deaths from cancer, and the success of interventions intended to detect cancer at an early stage greatly depends on cancer education and awareness and sensitivity to the needs, beliefs and unique circumstance of the target population. Although much remains to be learned about cancer, enough is now known about the causes of cancer and means of control for suitable intervention to have a significant impact. Most Africans cannot currently access curative therapies, state-of-the-art surgery or expensive cancer drugs that are the mainstay of cancer care in developed nations. At the same time between 30% and 50% of cancers are preventable, and a third of all cancers could be cured if detected early. Therefore, scaling up prevention and early diagnosis will be the most cost-effective ways of dealing with cancer. ACO is by this looking for partners with similar mandate to collaborate to establish and sustain the CIS.

Concern over cost of and access to cancer treatments: A meta-narrative review of nivolumab and pembrolizumab studies.

A better understanding of the modulation of the immune system has resulted in the development of new classes of antitumor agents such as nivolumab and pembrolizumab. Despite the proven effectiveness and tolerability of these new drugs for specific types of cancer, the high cost of treatment has affected their accessibility. The aim of this study is to conduct a meta-narrative review of studies that have addressed the concerns that have been voiced regarding the cost of and access to nivolumab and pembrolizumab in oncology health care. This meta-narrative review attempts to answer the following questions: (1) which papers have considered this broad topic area?; (2) what are the main empirical/theoretical findings?; and (3) what insights can be drawn by combining and comparing findings from different papers? A meta-narrative review has been conducted in 5 research databases (Web of Science, Science Direct, Scopus, Embase and Pubmed) without time limitations up to January of 2017 to address concerns related to the cost of and access to nivolumab and pembrolizumab in oncology health care. From each research base, articles were selected that had a key word related to the theme of pharmacoeconomics and nivolumab or pembrolizumab in any field of scientific work. The research questions were analyzed through the application of a meta-narrative review approach and the use of a convergence-coding matrix to summarize similarities and differences directly related to the research topic between the different papers. The first contribution of this meta-narrative review is that it summarizes economic-based works on the use of nivolumab and pembrolizumab, particularly for three therapeutic indications: melanoma, NSCLC and RCC. In general, despite the clinical benefit of nivolumab and pembrolizumab being well accepted and proven by scientific works, the published studies show that there are contradictory results with regard to the cost-effectiveness of these anti-PD-1s. The regulatory, economic and epidemiological variations mean that healthcare costs for cancer patients vary greatly from country to country and according to the type of tumor. The second contribution has to do with the recommendations for the development of high quality process for pharmacoeconomic analyses, especially in the new field of immuno-oncology. Finally, the third contribution is with regard to recommendations for the sustainable use of immunotherapies. Given the revolution in cancer therapy in recent years, the efficient allocation of existing resources is essential for healthcare systems to meet the evolving needs of populations and remain sustainable in the long term. The application of high quality information that stems from scientific evidence and economic modeling can help considerably to make the healthcare system sustainable over time mainly due to a higher number of therapeutic indications or more countries giving regulatory approval for the use of new and expensive cancer drugs.

Estimating The Drug Treatment Cost of Breast Cancer

Objectives Overall treatment costs in oncology are increasing rapidly due to the increasing availability of expensive drugs. Comparing the costs of currently used drugs and assessing the cost-effectiveness of new drugs requires a transparent overview of actual breast cancer treatment prices. As such an overview is lacking, this study aims to synthesize evidence on the reimbursement and costs to estimate the total treatment cost of expensive breast cancer drugs for the Netherlands. Methods Evidence on the approval, reimbursement and list prices of expensive breast cancer drugs was identified from the Dutch Administrative Health Authority (ZINL). Data on the average length of treatment and dosing schedules was obtained from European Parliament Assessment Reports (EPARs) or ZINL reports. All evidence was aggregated in the estimation of actual treatment cost. Results In the Netherlands, 31 breast cancer drugs are approved (available in 41 different forms). Based on drug list prices Pertuzumab, Trastuzumab Emtansine and Trastuzumab are the most expensive drugs. For 17/41 (41.5%), no evidence on the average treatment length was available in EPARs or ZINL reports. Comparing list prices to the estimated treatment cost per patient resulted in substantial differences in the ranking of expensiveness of the drugs. Overall, estimated treatment costs were highest for Bevacizumab, Pertuzumab and Trastuzumab Emtansine. Conclusions Estimating treatment costs is far from trivial, given the wide range of evidence sources that need to be synthesized. This complicates rapid and transparent assessment of actual cancer drug treatment cost, which is necessary to focus strategies aiming to limit the increasing healthcare costs. Differences exist in list prices within countries and between countries, thereby influencing the corresponding estimated treatment costs and resulting in list prices having limited value in this context. Therefore, extending standardization in presenting information on costs per cancer drug and implementing real world price estimates in such calculations is highly recommended.

1123P - The cost of expensive breast cancer drugs

Background: Increasing healthcare costs are a major challenge in medical oncology, since the total costs of oncology can account for up to 30% of the total hospital expenditures. As many novel (expensive) cancer treatments are being developed, it is important to be transparent about drug prices from an early research stage on. To assess the potential financial impact of pipeline drugs, their expected future prices can be deducted from prices of currently used drugs. As an overview of the standard prices of expensive breast cancer treatments in European countries is lacking, this review aimed to synthesize all evidence on costs of approved, expensive breast cancer drugs in the Netherlands. Methods: A literature review was performed to create an overview of all approved, expensive drugs in the Netherlands. Standard drug costs were retrieved via the Dutch administrative health authority (ZINL). Drugs were considered expensive if the standard price of the drug was more than €10 per unit or if the cost of a treatment with that particular drug exceeded €1000 on average per patient. Results: In the Netherlands 25 breast cancer drugs are approved with a standard price of more than €10 per unit. After excluding drugs with expected treatment costs less than €1000, 19 drugs were included in the analysis. The standard drug price is €7,943 on average (range €63 - €45,452), and the average number of cycles per patient is 10.5 (range 4 - 25.3 cycles). This results in average treatment costs per patient of expensive drugs of €17,968 (range €1,103 - €87,123). Four drugs that initially ranked low based on standard drug unit prices (rank 10-19), rank substantially higher (rank 1-10) when ranking total treatment costs. Conclusions: Ranking standard drug prices per unit may not be very informative. It would be valuable to rank drug treatment costs, based on treatment length and dosage estimates. However, in the Netherlands the expected treatment length for a particular drug is not standardly reported in official approval reports. Furthermore, actual prices of expensive drugs may differ from standard drug prices, by which treatment costs might be deviant. Extending standardization of reporting and calculation of drug treatment costs would be valuable and particularly relevant when extending this type of cost calculations to other countries. Legal entity responsible for the study: University of Twente - Health Technology and Services Research Funding: None Disclosure: All authors have declared no conflicts of interest.

Opportunities to significantly reduce expenditure associated with cancer drugs.

To identify cancer drugs amenable to strategies for reducing expenditure and avoiding drug wastage. Information was sourced from product information in 20 countries on parenteral cytotoxic agents, and cancer and noncancer monoclonal antibodies. Data were collected on vial sizes, overage, stability and presentation forms. Vial size availability varied significantly between countries, with often only single vial sizes for numerous medications. Overage was poorly reported. Stability data were inconsistent and variable between countries, with most drugs only having a 24 h expiry. Three cancer-indicated monoclonal antibodies, thought suitable for prefilled syringe administration, were only available as vials. Many expensive cancer drugs are suitable for global cost-reduction strategies. Collaboration is vital to affecting change and reducing expenditure.

Economic evaluation of brentuximab vedotin for persistent Hodgkin lymphoma.

We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (hl) in the post-autologous stem-cell transplantation (asct) failure period, from the perspective of the Canadian health care payer. We developed a decision-analytic model to simulate lifetime costs and benefits of brentuximab vedotin compared with best supportive care for the treatment of patients with hl after failure of asct. Administrative data from Ontario were used to set the model parameters. In the base case, treatment with brentuximab vedotin resulted in incremental quality-adjusted life-years (qalys) of 0.544 and an incremental cost of $89,366 per patient, corresponding to an incremental cost-effectiveness ratio (icer) of $164,248 per qaly gained. The icer was sensitive to the cost of brentuximab vedotin, the hazard ratio used to assess the efficacy of brentuximab vedotin treatment, and health state utilities. In light of the available information, brentuximab vedotin has an icer exceeding $100,000 per qaly gained, which is a level often classified as having "weak evidence for adoption and appropriate utilization" in Canada. However, it is worth noting that provincial cancer agencies take into account not only the costs and associated icer, but also other factors such as a lack of alternative treatment options and the clinical benefits of expensive cancer drugs. Pricing arrangements should be negotiated, and risk-sharing agreements or patient access schemes should be explored.

Cancer groups concerned with Medicare proposal

Cancer groups concerned with Medicare proposal

Implementation of ipilimumab therapy in a private practice oncology group: overcoming start-up and reimbursement issues related to expensive new cancer drugs

Implementation of ipilimumab therapy in a private practice oncology group: overcoming start-up and reimbursement issues related to expensive new cancer drugs

Actual costs of cancer drugs in 15 European countries

The financial sustainability of cancer services as part of national health systems is a major challenge;1 oncology consumes up to 30% of total hospital expenditure and the amount spent on expensive cancer drugs is rising fast.2 In view of the pipeline of new drugs, these costs are likely to continue to grow.3 Apart from the risk of unequal access between European countries, burdening health systems with fast-growing costs for these drugs means that the sustainability of cancer care could be compromised. One element increasingly under scrutiny is the pricing policy of pharmaceutical companies. Both in the recent American Society of Clinical Oncology (ASCO) meeting and in various publications,4, 5 and 6 attention has been drawn to the lack of transparency on the pricing of various drugs. Different models to judge the appropriateness of prescribing drugs have been proposed; the European Society for Medical Oncology (ESMO) and ASCO models try to balance cost and effectiveness. However, a wholehearted decision to include cost effectiveness as a criterion does not yet seem possible. An overview of actual prices in European countries does, to our knowledge, not exist, and anecdotal evidence has suggested that differences in price levels might be high. We surveyed the prices for several cancer drugs in European countries through the membership of the European Organization of Cancer Institutes (OECI) and Cancer Core Europe.7 A word-based survey was emailed to all full members of the OECI (n=51), both European Union (EU) members and non-EU members, and to the non-OECI member of Cancer Core Europe. The survey was sent to the board of the centre; for most centres the leading pharmacist responded, together with an oncologist. We asked centres to provide list or official and actual prices, corrected for VAT differences, and asked for information about central or government coordinated purchasing. The actual price was defined as the net price—ie, as price per one dose (eg, one 100 mg vial or one capsule of 12·5 mg) to allow for a comparison in case of different pack sizes. Any type of discount was taken into account because we asked the centres to provide us with the price they actually pay. We received a response from 21 centres from 15 countries. Most responses were received in June and July 2015. For some countries we received more than one response and from these we present an average.

Out-of-pocket costs and oral cancer medication discontinuation in the elderly.

Cancer is a major cause of mortality and a major contributor to health care costs in the United States. An increasing number of cancer patients are treated with oral cancer therapy. Older patients are more likely to have cancer and to be at risk for adherence problems with oral cancer drugs. As a result of substantial cost sharing required for oral cancer drugs and the possibility of early entry into the Medicare Part D coverage gap, high out-of-pocket (OOP) drug costs could put elderly beneficiaries at great risk for delaying or discontinuing their cancer therapies. To (a) determine the OOP costs of oral cancer treatment and the numbers of patients that delay or discontinue oral cancer therapy and (b) examine the relationship between OOP costs and medication discontinuation or delay among older Medicare beneficiaries. A cross-sectional study was conducted using a 5% sample of Medicare beneficiaries who filled a prescription for imatinib, erlotinib, anastrozole, letrozole, or thalidomide during 2008. Patients included in the analysis sample did not receive drug subsidies, were aged 65 years or older, and were enrolled in Medicare Part D for all 12 months of 2008. Logistic regression was used to determine the association between OOP costs and medication discontinuation or delay. Mean OOP costs per day were $2.96 for anastrozole, $3.10 for letrozole, $22.90 for imatinib, $28.35 for erlotinib, and $37.47 for thalidomide. The percentages of patients who discontinued or delayed oral cancer therapy were 58% for anastrozole, 64% for letrozole, 35% for imatinib, 61% for erlotinib, and 70% for thalidomide. For each $10 increase in OOP spending per month, the likelihood of discontinuation or delay increased 13%, 14%, and 20% for imatinib, erlotinib, and thalidomide users, respectively, but decreased 26% for anastrozole and letrozole users. Beneficiaries with higher OOP costs for the more expensive oral cancer drugs were more likely to discontinue or delay drug therapy.

Comparative cancer survival in European countries

Survival for patients with cancer varies widely across Europe. This review is an attempt to explore some of the factors that influence this variation. The data on cancer survival come from EUROCARE-5 and a recent OECD report. These figures have been analysed together with data from a variety of other sources: other OECD data sets; EUROSTAT; The World Bank; Gallup and the World Health Organisation. This study confirms the importance of national socio-economic factors in influencing the outcomes for patients with cancer. The usual suspects (limited access to expensive new cancer drugs; delayed diagnosis and late presentation) may have less influence on cancer survival than is usually assumed. Disparities in outcomes challenge systems of health care to re-evaluate their strategies. The key point is that these new strategies need to be informed by facts, rather than suppositions. The role and scope of national cancer registries should be enhanced. We need to record more detailed information on each patient with cancer and, in an era of linked data, cancer registries are ideally placed to collect and curate such information.

Abstract P3-12-11: Provincial variation in utilization of adjuvant chemotherapy regimens in early stage breast cancer: Data from the cancer care Ontario new drug funding program (NDFP)

Abstract Objectives: Recent improvements in breast cancer mortality are partly due to increased utilization of appropriate systemic therapy in early stage disease. The objectives of this study were to 1. review utilization of the most effective adjuvant breast cancer regimens across Ontario, 2. identify regions where there are variations from best practices. Methods: We used data from the Ontario NDFP to determine the utilization of 8 drug regimens approved for early stage breast cancer in each of the 14 provincial local health integration networks (LHINs). The NDFP funds the use of new and expensive cancer drugs; over 90% of all cancer treatments are funded through this mechanism. In Ontario, there were an estimated 9000 new cases of breast cancer in 2011. The analysis was restricted to patients with early stage, Her2 negative breast cancer treated in 2011-12. Data were obtained from individual cancer clinics in each LHIN. We estimate that data collection was >95% complete for these regimens. Results: 3375 women were treated with an NDFP regimen. Across the province, the most commonly used regimen was FEC-D (43%), followed by TC (23%) and ddACT (21%). The remaining regimens (AC-Docetaxel, ACT q 3 wks, CEF, FEC and AC-weekly P) were used in less than 5% of cases. However, there was important regional variation. In LHIN A, ACT q 3 wks was used in 42% of cases, and no patients received FEC-D. In LHIN P, TC was used in 40% of cases. In LHIN R, only 6% of patients received FEC-D, whereas 63% received ddACT. Utilization of Adjuvant Chemo Regimens n = 3375 AC-DocetaxelddACT q2wksACT q3wksAC-weekly PCEF/FECTCFEC-DLHIN K212004109241LHIN J3417101545212LHIN Q12000640104LHIN D1530732568165LHIN V57120031027LHIN R5188390104018LHIN P2246184111115LHIN B35311182795LHIN C0588002326LHIN A0132581120LHIN H2410189109LHIN T510425466038LHIN M1011318319175263LHIN S1715004728Total (%)128 (4)708 (21)156 (5)37 (1)139 (4)766 (23)1441 (43) Conclusion: The ACT q3 wks and TC regimens are widely used. This is of concern as they are likely less effective than FEC-D or ddACT. Factors such as tumour stage, geographic distance from treatment centre and private insurance coverage for supportive care medications may also affect choice of regimen. Consensus guidelines for the adjuvant systemic therapy of breast cancer in Ontario are being developed, along with a knowledge translation strategy to disseminate the results. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-12-11.