Financial Assistance Programs Research Articles

"Diagnosed with New Health": Social Security Policy Recommendations for People with Cycstic Fibrosis in Ohio Transitioning to a Longer Lifespan

Cystic fibrosis (CF) is a chronic, progressive, genetic, and life-limiting lung disease that impacts approximately 105,000 individuals globally, including 40,000 individuals in the United States. In 2019, a revolutionary new drug, elexacaftor/ivacaftor/tezacaftor (ETI), was approved to manage some of the major symptoms of CF and dramatically increase the lifespan of people with cystic fibrosis (pwCF). Many individuals with CF cannot work full time and require Medicaid, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), and other financial assistance programs to pay for treatments and medical expenses. Yet in recent years, pwCF who are on ETI have been increasingly losing benefits. A possible explanation for this is the effectiveness of ETI in improving lung function, creating the perception that pwCF are no longer disabled by their condition. Even with this “miracle" drug, pwCF continue to experience significant complications and vulnerabilities to their physical and mental health as well as limitations on daily living and employment. The compounded vulnerabilities these individuals experience leave them without a safety net. Social Security policies for pwCF require revisions to prevent further biopsychosocial damage to this population. Two policies will be recommended: leniency in redetermination, and CF education for those who make determination decisions.

Abstract PO1-09-06: Patient Barriers to Genetic Counseling

Abstract Patient Barriers to Genetic Counseling Background: Access to genetic counseling is becoming more important as new targeted drugs are developed and as recommendations for testing for hereditary cancer syndromes expands. Yet, significant barriers hinder patients’ access to these services leading to a certain percentage of patients declining a genetic counseling referral (Ochoa, O’Neill). Among one of the more often cited reasons for declining genetic counseling is the cost of the consultation when it is not covered by insurance or a patient is uninsured. This potentially limits patient treatment options and can result in a missed opportunity to identify at-risk relatives. There is scant data documenting why women do not accept genetic counseling referrals and our study sought to better identify these potential barriers. In doing so we hope to enable healthcare providers and policymakers to develop strategies to ensure equitable access to these crucial services. Methods: Breast cancer patients for whom a genetic counseling referral was placed and who self-declared the inability to pay our Cancer Center’s genetic counseling fee ($126) were approached about filling out an anonymous survey regarding their reasons for declining. The survey queried, in addition to cost, other patient-related barriers to genetic testing. The survey also captured the number of first-degree relatives who might be affected by an actionable pathogenic variant. After patients were consented and completed the survey, genetic testing, paid for by the study, was offered. Results: To date, 13 patients were approached about the study and 10 patients (77%) agreed to participate, were consented and filled out surveys. Women could choose more than one reason for declining a genetic counseling referral but the most prevalent reasons cited were cost (10), worried there is nothing to be done about inherited cancers (3), concern about genetic material being taken and/or results being used against them (2), too many appointments (2). Of these 10, all (100%) elected to proceed with genetic counseling and all 10 (100%) elected to proceed with genetic testing. Two of the 10 patients (20%) tested were found to have actionable pathogenic variants (one in BRCA2 and one in CHEK2) potentially impacting 13 adult first-degree relatives. Conclusion: These preliminary findings underscore the importance of access to genetic counseling in order to facilitate appropriate genetic testing. The identification of actionable genetic mutations allows for early detection, timely interventions, and tailored management plans, ultimately leading to improved patient outcomes. By identifying cost as the most often cited reason for declining genetic counseling, healthcare providers and policymakers can develop strategies such as the implementation of financial assistance programs and universal insurance coverage for genetic counseling services in order to alleviate the financial burden and ensure equitable access to these crucial services.

Clinical Outcomes of Patients with Newly Diagnosed Large B-Cell Lymphoma in a Safety-Net Hospital System

Real-world outcome data for patients with large B-cell lymphomas (LBCL) who are uninsured or have socioeconomic barriers to care are limited. We performed a retrospective cohort study of patients with newly diagnosed LBCL treated in a large safety-net hospital system. Between January 2011 and June 2022, 496 patients ages >18 years were diagnosed with LBCL at Harris Health System, Houston, TX. The median age was 53 years, 75% were uninsured, and 81% were in the most disadvantaged Area Deprivation Index national quartiles. Most (69%) had stage III/IV disease, 44% had poor-risk disease by the Revised International Prognostic Index (R-IPI), and 17% had a history of HIV infection. The median diagnosis-to-treatment interval was 17 days. The median follow-up time was 53.5 months. Among 464 evaluable patients, 66% achieved a complete response, and 11% had a partial response. Twenty-six (54%) of 48 patients eligible for cell therapies received them. At 5 years, event-free and overall survival (OS) rates were 57% and 68%, respectively. Factors that affected OS included Hispanic ethnicity (HR 0.70, p=0.027), R-IPI (HR 4.67 for poor- vs. very-good-risk, p<0.001), National Cancer Institute Comorbidity Index (HR 1.53 per unit increment, p=0.003), hemoglobin (HR 0.89 per unit increment, p=0.002), and International Normalized Ratio (HR 2.17 per unit increment, p=0.007). Insurance status was not associated with differences in OS. In our safety-net health system with robust financial assistance programs and limited access to cell therapies, uninsured status was not associated with inferior outcomes. Addressing barriers to care may improve outcomes in other settings.

Pharmacy Prescription Assistance Program: Evaluation of a Health System Retail Model for Outpatients

Background: Access to essential medications remains a challenge, especially among socioeconomically disadvantaged populations. In 2021, 18 million U.S. adults struggled to afford prescribed medications, a problem exacerbated by the prevalence of chronic conditions like diabetes, hypertension, and mental health disorders. The 340B Drug Pricing Program has enabled eligible healthcare organizations to purchase drugs at reduced prices, thus enhancing medication accessibility for financially constrained patients. This study explores the impact of the Retail Pharmacy Prescription Assistance Program within a 340B-eligible health system in addressing this issue. Objective: To evaluate the effectiveness of a Retail Pharmacy Prescription Assistance Program in increasing access to essential medications and reducing financial burden for eligible outpatients within a 340B-eligible health system. Methods: This exploratory study was conducted at a 340B-eligible academic medical center and focused on the implementation of the Retail Pharmacy Prescription Assistance Program (RPPA Program). Eligible patients, already enrolled in the health system’s financial assistance program, were identified, and assessed for additional eligibility for the RPPA Program, ensuring prescriptions were written by internal providers and that patients did not have access to other financial assistance resources. Data collected included patient demographics, medication history, dispensed prescriptions, out-of-pocket patient savings, and pharmacist interventions. Results: During the study, 156 patients were enrolled. About half (51%; n = 79) did not utilize its services due to reasons such as the absence of active prescriptions, prescriptions from external providers, or existing coverage by the patients’ insurance. Of the 563 prescriptions clinically evaluated, 72% (n = 407) were dispensed free of charge to 77 patients, resulting in $13,945 in out-of-pocket patient savings. Of the total prescriptions assessed, 28% (n = 156) were not included on the RPPA Program formulary and were not changed to a RPPA formulary alternative for various reasons, such as a formulary alternative was not available, or the patient opted not to switch to formulary alternatives. Conclusions: The RPPA Program proved effective in reducing financial barriers to accessing essential outpatient medications. While it yielded positive outcomes, the program’s benefit was constrained to a limited patient demographic, underscoring the imperative to expand identification and engagement strategies to include a broader patient population.

Navigating Loan Recovery Process from SMEs: Identifying Critical Challenges for Microfinance Institutions in Tanzania

The purpose of the study is to examine the loan recovery challenges facing Microfinance Institutions (MFIs) and Small and Medium Enterprises (SMEs) in Tanzania. The study took place at Nuru Financial and Business Services (NFBS), the Self-Microfinance Fund (SMF), and Ameic Microcredit Limited (AMC). These are among the microfinance institutions found in Dar es Salaam. The researchers employed a descriptive research design and used NFBS, SMF, and AML as study cases. The study involved 50 respondents, including credit officers, obtained through simple random sampling. In the data collection, the study used semi-structured questionnaires to gather primary data. Also, the study used secondary data from documents available at NFBS, SMF, and AML. Data were analysed using simple descriptive statistics with frequency, percentages, and mean. The study found that loan recovery was a challenging task and faced several obstacles, such as insufficiency of capital to cover recovery costs, the presence of weak internal controls on loan recovery, higher interest rates, and facing an extraordinary event during the loan recovery process. Others are getting into bitter relations with customers during loan recovery due to the incompetence of staff to address loan recovery processes. Finally, the study recommends the government provide financial support or subsidies to microfinance institutions to cover recovery costs, such as grants, low-interest loans, or financial assistance programmes. Establish and enforce regulatory standards for internal controls within microfinance institutions. Implementing policies to regulate interest rates charged by microfinance institutions to ensure fairness and transparency. Establish a legal framework to handle extraordinary events during the loan recovery process. Microfinance institutions should explore partnerships with international development organisations, impact investors, or donor agencies to secure additional funding for loan recovery efforts. Loan officers should be trained in cost-effective recovery strategies, and SMEs should engage in responsible borrowing practices to minimise the risk of default.

Response of consumers to wage shocks in the framework of the Portuguese assistance program

AbstractThis paper studies the impact on consumption of the exogenous changes in public wages in Portugal during and after the economic and financial assistance program (2011-2014), by exploiting the variability in the size of such changes across municipalities. The initial wage cuts triggered a marked reduction of private consumption, while the reinstatements in the later years gave rise to an increase, albeit of a smaller magnitude. The consumption response was larger for employees with relatively lower wages. Households smoothed the impact on consumption of negative income shocks partly by drawing down their deposits. Consumer credit did not play such a role, as households deleveraged as a response to those negative shocks.

Assessing Attitudes and Understanding After Ovarian Tissue Cryopreservation: A Follow-Up Telephone Interview Survey.

Purpose: Assessing patient and guardian experiences regarding their history of ovarian tissue cryopreservation (OTC) years after initial procedure. Methods: Cross-sectional follow-up telephone survey. A questionnaire developed by The Pediatric Initiative Network of the Oncofertility Consortium, modified to assess intent and attitudes regarding OTC, tissue access knowledge, financial burden of tissue storage, and intent to use tissue, was utilized. Interviews were conducted for those who underwent OTC at a metropolitan children's hospital between 2013 and 2022. Results: Of 60 eligible patients, 39 interviews were completed. Contacted patients were 3-28 years old, with minors accompanied by guardians. Average age at OTC was 8.5 years old, and 5.1% (2/39) were deceased at the time of contact. All interviewees underwent OTC for fertility preservation before gonadotoxic treatment. Seventy percent of patients (7/10) and 48.1% (13/27) of guardians stated they would use frozen tissue for pregnancy, with 50% (5/10) of patients and 59.3% (16/27) of guardians not understanding tissue access. Regret occurred in 10% (1/10) of patients and 3.4% (1/29) of guardians. It was associated with 10.8% (4/37) of tissue discard due to failed storage payments. Financial concerns occurred in 29.7% (11/37) of interviewees. Overall, 92.3% (36/39) would recommend OTC, and 94.9% (37/39) would repeat their choice to undergo OTC. Conclusion: Follow-up after OTC is essential to patient understanding of tissue status, access, and payments. Most do not regret OTC, except in cases of financial burden leading to tissue discard. Follow-up should be sequentially scheduled and include counseling on financial assistance programs.

Wigs and Alopecia Areata: Psychosocial Impact and Economic Considerations

Alopecia areata (AA) presents a challenging and unpredictable condition associated with substantial psychosocial and financial burdens. A chronic, relapsing form of non-scarring hair loss, it affects approximately 0.1–0.2% of the population worldwide with a lifetime risk of 1.0% to 2.1%. The psychosocial implications of AA, including its association with depression, anxiety, social phobia, employment disruption, and relationship challenges are well described. Significant economic costs of AA include those of healthcare, lost income, transportation, psychotherapy, and cosmetic accessories (wigs and hairpieces). However, wigs and hairpieces can contribute to enhanced self-esteem, confidence, and overall quality of life (QOL) in AA patients; these positive outcomes correlating with satisfaction in appearance. This article explores the role of wigs in addressing the aesthetic and emotional impact of AA, emphasizing their importance as potential coping mechanisms for individuals facing hair loss whilst also acknowledging possible barriers to their use. Different types of wigs and hairpieces, their respective advantages and disadvantages, and methods of attachment are thoroughly discussed, providing a comprehensive overview for both patients and healthcare professionals. Considering the economic impact of AA, this article explores the cost of wigs in Australia and available financial assistance programs. Wigs can play a pivotal role in rapidly addressing the multifaceted challenges posed by AA, offering time for psychosocial adaptation and delayed response to medical therapies. This review aims to provide valuable insights to inform evidence-based, practical, and personalized counselling of patients with AA and enable shared decision making about the utility of wigs and other cosmetic interventions for hair loss. Further research is warranted to explore differences in the optimal utilization of wigs between diverse sub-populations with AA.

IJCM_228A: Awareness &amp; possession of health insurance scheme and its impact on health care utilization amongst people seeking services in tertiary care hospitals of coastal Karnataka: A cross-sectional study

Background: Healthcare is a fundamental human right, and various insurance schemes in India strive to make healthcare inexpensive and accessible to everyone. The government’s Ayushman Bharat and PMJAY programmes aim to guarantee universal health coverage and financial risk protection for households within the country. According to the NITI Ayog, more than 40 crore people lack health insurance coverage in the country. This lack of awareness limits access to healthcare services, especially for the marginalized population. The focus of this study is to assess the impact of availing health insurance on healthcare utilization. Objective: To assess the level of awareness and proportion of patients who are availing health insurance scheme and its impact on healthcare utilisation. Methodology: This cross-sectional study was carried out at teaching hospitals affiliated with Kasturba Medical College, Mangalore. The sample size was estimated to be 118, which included the adult patients admitted to the wards of respective hospitals who gave informed consent. The study participants received an internally verified questionnaire with four sections in Kannada and English. Results: Out of 118 participants, 89% are literate, and two-thirds are holders of BPL card. 84% of study participants are aware of a certain health insurance scheme, among which 90% being aware of the services offered and 82% considering it may be a worthwhile investment. 60% of total respondents possessed any kind of insurance scheme, with three quarters of them utilizing government schemes. Among the insurance holders, 82% receive full reimbursement for their medical condition and 58.5% agree that owning health insurance enables them greater access to health-care services. Paying medical expenses out of pocket drives uninsured people to reconsider obtaining an insurance. Conclusion: Public awareness and financial assistance programs should be tailored with culturally competent communication and simplified enrolment processes to enhance the coverage of health insurance services.

Cost sharing for oral lenvatinib among commercially insured patients.

To use a nationwide pharmaceutical claims database to evaluate cost-sharing trends for commercially insured patients with cancer who were prescribed lenvatinib(Lenvima). IBM MarketScan databases were used to evaluate lenvatinib costs for patients with employer-based commercial insurance, and for patients 65 years and older, Medicare claims for fee-for-service plans. Patients were included if they had least 1outpatient pharmaceutical claim for lenvatinib paid on a noncapitated basis from 2015 to 2019. Median and IQR costs were estimated and inflation adjusted to 2019 US$ for 30-day supplies and reported as total, insurance liability, coordination of benefits, and out-of-pocket costs. A total of 685 patients had at least 1 pharmaceutical claim for lenvatinib, which included patients with thyroid (n = 251; 36.6%), renal cell (n = 202; 29.5%), hepatocellular (n = 160; 23.4%), and endometrial (n = 48; 7.0%) cancer. The median (IQR) number of prescriptions per patient was 3 (2-7), and the median (IQR) total days of supply was 90 (45-210) days. The median (IQR) 30-day cost of lenvatinib was $17,253 ($15,597-$18,120). Median (IQR) 30-day insurance liability was $16,847 ($15,000-$17,981). Median (IQR) 30-day coordination of benefits was $0 ($0-$0). Median (IQR) 30-day patient out-of-pocket cost was $32 ($0-$100). However, the maximum 30-day out-of-pocket cost in our patient cohort was $12,538. In this cohort, insurance was liable for the majority of total lenvatinib drug costs, and 75% of patients paid $100 or less per month out of pocket. This information can be used by care teams to counsel insured patients. Health systems and drug manufacturers must identify patients with high out-of-pocket costs and provide convenient access to financial assistance programs so that patients are not forced to forgo the benefits of these drugs due to financial barriers. Value-based payment models and drug pricing reform are also needed to address underlying drivers of high drug costs.

Access to Financial Assistance Programs and Their Impact on Overall Spending on Oral Anticancer Medications at an Integrated Specialty Pharmacy.

Financial assistance (FA) programs are increasingly used to help patients afford oral anticancer medications (OAMs), but access to such programs and their impact on out-of-pocket (OOP) spending has not been well explored. This study aimed to (1) characterize the impact of receipt of FA on both OOP spending and likelihood of catastrophic spending on OAMs and (2) evaluate racial/ethnic disparities in access to FA programs. Patients with a cancer diagnosis prescribed an OAM anytime between January 1, 2021, and December 31, 2021 were included in this retrospective, single-center study at an integrated specialty pharmacy affiliated with a tertiary academic cancer center. Fixed-effect regression models were used to characterize the impact of receipt of FA on overall spending and likelihood of catastrophic spending on OAMs, as well as explore the association of race/ethnicity with receipt of FA. Across 1,186 patients prescribed an OAM, 37% received FA. Receipt of FA was associated with lower annual spending on OAMs (β = -$1,236 US dollars [USD; 95% CI, -$1,841 to -$658], P < .001) but not reduced risk of catastrophic spending (odds ratio [OR], 0.442 [95% CI, 0.755 to 3.199], P = .23). Non-White patients (OR, 0.60 [95% CI, 0.43 to 0.85], P = .004) and patients who spoke English as a second language (OR, 0.46 [95% CI, 0.23 to 0.90], P = .02) were less likely to receive FA compared with White and English-speaking patients, respectively. FA programs can mitigate high OOP spending but not for patients who spend at catastrophic levels. There are racial/ethnic and language disparities in access to such programs. Future studies should evaluate access to FA programs across diverse delivery settings.

Turn down your thermostats – A contribution to overcoming the European gas crisis? The example of Germany

Europe's current gas crisis requires rapid government intervention to curtail natural gas consumption and mitigate expenses for consumers. This study aims to comprehensively assess the impact of adjusting thermostats, with single-family houses in Germany serving as a case study. A unique bottom-up approach for approximating gas consumption at the level of building archetypes reveals that decreasing temperature setpoints from 21 °C to 19 °C and 17 °C can save about 14 and 30 TWh/a of gas, respectively. This corresponds to 3–6 % of gas imports from Russia to Germany in 2020. The largest absolute savings can be realized in older and larger buildings. Additionally, our findings suggest that the adjustment of thermostats may decrease residential CO2 emissions by 3–6 Mt/a, achieved through a reduction of 2–4 °C in the setpoint. Therefore, the measure shows great promise regardless of the present crisis. From the consumer's perspective, a 1 °C temperature reduction can lead to a gas bill reduction of 4–9 %, contingent upon building type. Nevertheless, the cost burden associated with rising gas prices surpasses these savings. Residents of older buildings suffer more severe financial impacts than those in newer ones. Our research suggests that policymakers should consider implementing adjustments to residential thermostats. Furthermore, consumer financial assistance programs should factor in building type when designing relief mechanisms.

&lt;b&gt;The Impact of Behavioral Organization Development Interventions on Employee Development and Organizational Performance. A Mixed Methods Approach&lt;/b&gt;

Corporate planners have found that organisational performance (OP) presents a significant strategic challenge and complication. They are looking for solutions to the problem of how to maintain their competitiveness in the global market while establishing a strategic position. Organizational development (OD) interventions provide solutions to these challenges and complications. We employed the mixed-methods explanatory sequential design and tested the effects of seven OD behavioral interventions on OP, including coaching, reward systems (RS), career development plans (CDP), financial assistance program (FAP), pay systems (PS), and training and development (T&amp;D). The aim of this study was to support corporate planners and practitioners. We defined the OP as growth in financial performance (FP) (G). We employed employee development (knowledge, skills, and abilities) as a mediator. We sent 800 (sample size) questionnaires to HR heads, and 762 completed ones were returned. We use a stratified random probability sampling method to choose a sample of 800 firms from the population, which is all listed firms with the Security and Exchange Commission of Pakistan (SECP). We employed SPSS Version 20 to perform regression analysis. We calculated coefficient β values, t- and p-values, adjusted R2, and F-statistic values were computed and determine the causal influence. We conducted mediation analysis the four-step method proposed by Baron and Kenny (1986). Goodman and Sobel Preacher and Leonardelli (2001) used a web-based technique to conduct tests to confirm the mediations among variables. We conducted a focus group of ten OD professionals to gather qualitative data, conducted thematic analysis then merged the data to obtain insightful findings. The findings are valuable for OD practitioners and the study is a step towards a Green-OD Community.

Lessons Learned From Applying a Monitoring and Evaluation Framework to Economic, Social, and Other Health Impacts of the COVID-19 Pandemic.

Individual and community-level COVID-19 mitigation policies can have effects beyond direct COVID-19 health outcomes, including social, behavioral, and economic outcomes. These social, behavioral, and economic outcomes can extend beyond the pandemic period and have disparate effects on populations. Public Health-Seattle & King County (PHSKC) built on the Centers for Disease Control and Prevention's community mitigation strategy framework to create a local project tracking near-real-time data to understand factors affected by mitigation approaches, inform decision-making, and monitor and evaluate community-level disparities during the pandemic. This case study describes the framework and lessons learned from PHSKC's collation, use, and dissemination of local data from 20 data sources to guide community and public health decision-making. Social, behavioral, economic, and health indicators were regularly updated and disseminated through interactive dashboards and products that examined data in the context of applicable policies. Data disaggregated by demographic characteristics and geography highlighted inequities, but not all datasets contained the same details; local surveys or qualitative data were used to fill gaps. Project outcomes included informing city and county emergency response planning related to implementation of financial and food assistance programs. Key lessons learned included the need to (1) build on existing processes and use automated processes and (2) partner with other sectors to use nontraditional public health data for active dissemination and data disaggregation and for real-time data contextualized by policy changes. This project provided programs and communities with timely, reliable data to understand where to invest recovery funding. A similar framework could position other health departments to examine social and economic effects during future public health emergencies.

Exploring Regional Challenges and Solutions to Appropriate and Equitable Care for Patients with Chronic Lymphocytic Leukemia

Background: For patients with chronic lymphocytic leukemia (CLL)-the most common form of leukemia in older adults-equitable access to care is particularly challenging, as the disease is often diagnosed in community cancer centers encumbered by regional disparities. Therefore, identifying and understanding regional barriers to care is essential. In 2020, the Association of Community Cancer Centers (ACCC) developed a heat map detailing the incidence rate of CLL diagnoses across the country (Fig.1), overlayed with the locations of CLL “expert” providers, revealing the areas in the US most in need of additional CLL clinical expertise (Fig. 2). In 2022, these incidence rates were stratified by race, ethnicity, and metropolitan statistical area to identify disparities Building on these maps, ACCC set out to identify specific regional challenges to appropriate, equitable care for patients with CLL. Methods: As part of an independent education program, ACCC initiated conversations with providers about the regional barriers that patients with CLL face. Through 4 webinars in February 2023, participants from 4 regions-Northeast (New York and Maine), Northwest (Montana and Idaho), Midwest (Wisconsin, Illinois, and Iowa), and Southwest (Texas)-shared insights on challenges and exchanged ideas on strategies to improve care for patients with CLL. In addition, ACCC interviewed 3 regionally diverse cancer programs (from the US Northwest, South, and Southwest regions) that are effectively overcoming regional challenges to reach their patient populations and provide equitable care. These interviews highlighted barriers and challenges, showcased effective outreach campaigns, and explored how the outreach improved the patient journey. Findings: The following themes emerged as key challenges and potential solutions throughout all regions studied: (1) Comprehensive Diagnostic Work-up Before Treatment Initiation: A key component in caring for patients with CLL is identifying certain disease related criteria prior to formulating a treatment plan. This includes determining the disease burden, disease-related symptoms, and if the patient meets certain active disease criteria (eg, Binet Stage C or Rai Stage III or IV). Further, by utilizing genetic testing, such as the TP53 gene mutation and IGHV mutation tests, physicians can estimate time to treatment and choice of specific novel targeted therapies. (2) Understanding Patient Population Needs: Cancer programs must understand the needs of their unique patient populations to effectively address them. For example, in the Northwest, as mountainous passes can make travel dangerous at times, one local program utilizes near-campus housing/hotel space for patients for the duration of their intensive treatment. In the Southwest, addressing health insurance coverage, low health literacy, language barriers, patient-provider mistrust, and culturally competent care for undocumented individuals presents challenges to equitable care delivery. Therefore, cancer programs in this region have implemented protocols to utilize community and social services to help support these patients. (3) Developing Community Partnerships: As the median age of diagnosis with CLL is approximately 70 years old, barriers such as transportation availability, caregiver support and financial constraints could be magnified. Building trust, particularly among vulnerable communities, also presents a significant challenge. By partnering with community outreach organizations, programs can help address these issues through community resources such as ride share programs, transportation vouchers, and financial assistance programs. (4) Provider Education and Learning: Because many patients are diagnosed in community cancer programs and smaller practices where physicians do not often have experience with CLL, nationally available provider education on new developments in testing and treatments is key. Conclusions: ACCC identified regional challenges and solutions to appropriate and equitable care for patients with CLL, including the importance of comprehensive diagnostic work-up before treating, understanding the regional needs of patient populations (particularly underserved populations), building community partnerships, and engaging in targeted provider education.

Clinical Outcomes of Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma in a County Hospital System

Introduction: Advances in the treatment of diffuse large B-cell lymphoma (DLBCL) have improved survival, with Surveillance, Epidemiology, and End Results (SEER) Program data showing 5-year overall survival (OS) of 64.7% (SEER*Explorer, 2023). However, insurance status in the US is related to DLBCL survival (Han et al., Cancer 2014), and real-world data for patients who are uninsured or who may have socioeconomic barriers to care remain limited. We performed a retrospective cohort study to examine outcomes for patients with newly diagnosed DLBCL treated in a large safety-net hospital system in the third most populous county in the US. Methods: Patients aged 18 years and older diagnosed with DLBCL between January 2011 and June 2022 and treated at Harris Health System, Houston, TX, were included in the analysis. Demographic, disease, treatment, response, and follow-up data were abstracted from the electronic medical record. US Census Block Group FIPS codes derived from geocoded home address at the time of initial diagnosis were used to compute the Area Deprivation Index (ADI). Eligibility for cellular therapies including hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor T-cell therapy (CAR-T) was determined by the abstractors. Time-to-event analysis was performed using the Kaplan-Meier method, and Cox proportional hazards regression was used to examine factors associated with event-free survival (EFS) and OS. Results: Among 461 patients with newly diagnosed DLBCL (Table 1), the median age was 53 years (range, 18-93), 75% were uninsured, and 80% were in the most disadvantaged ADI national quartiles, defined as at or above the fiftieth percentile. Most patients had stage III or IV disease and an Eastern Cooperative Oncology Group Performance Status (ECOG) of 0 to 1 at the time of diagnosis. One hundred ninety-eight patients (44%) had poor-risk disease by the Revised International Prognostic Index (R-IPI). Seventy-five (16%) had a history of HIV infection. Common first-line treatments included R-CHOP ( n = 210, 46%) and R-EPOCH ( n = 183, 40%); 18 received no therapy (3.9%). The median time from diagnosis to treatment initiation (DTI) was 18 days (range, 0-246); 76% completed therapy. Of 425 evaluable patients, 288 (68%) achieved a complete response (CR) and 44 (10%) had a partial response (PR); of these, 74 (22%) relapsed. Twenty-five (58%) of 43 patients eligible for cellular therapies at relapse received them: 14 (56%) underwent autologous HSCT, 8 (32%) received CAR-T, and 3 (12%) had both. Median follow-up time for the cohort was 48.8 months (range, 0.2-147). By the time of analysis, 167 patients (36%) had developed refractory/relapsed disease, and 148 (32%) had died. At 1, 2, and 5 years, EFS was 72%, 64%, and 58%, and OS was 82%, 76%, and 69% (Figure 1). At 1, 2 and 5 years, EFS was 77%, 69%, and 64% and OS was 85%, 79%, and 75% for patients with germinal center B-cell-like (GCB) DLBCL, whereas EFS was 68%, 56%, and 50% and OS was 80%, 73%, and 62% for those with non-GCB DLBCL. In multivariable Cox regression models, predictors of OS were poor-risk disease by R-IPI (HR 6.08 compared to very-good-risk disease, 95% CI 1.02-36.09), ECOG (HR 2.10 for ECOG ≥2 compared to 0-1, 95% CI 1.12-3.95), and normalized LDH (HR 1.07 per fold increase, 95% CI 1.03-1.11). Race/ethnicity, insurance status, and DTI were not associated with significant differences in OS. However, receiving fewer than planned cycles of first-line therapy was associated with higher mortality (HR 2.00, 95% CI 1.12-3.56), as was not attaining CR by the end of first-line therapy (HR 7.90, 95% CI 3.65-17.12). Conclusion: This is one of the largest real-world studies to date examining outcomes of patients with newly diagnosed DLBCL at a safety-net hospital system. Overall, patients had shorter EFS and OS compared to historical clinical trials but had similar OS to SEER estimates. In this health system with robust financial assistance programs and access to cellular therapies for some patients, uninsured status was not associated with inferior outcomes. Addressing barriers to care may improve outcomes for uninsured patients in other settings.

DETERMINANTS OF SELLING LIVESTOCK TO PAY WATERING CHARGES BY PASTORALISTS IN SEMI-ARID AREAS OF MONDULI DISTRICT, TANZANIA

In semi-arid areas, the practice of selling livestock is crucial to support the livelihood of pastoralists and to pay for watering charges. However, it is not a widespread practice in developing countries such as Tanzania. This paper investigates why pastoralists in the semi-arid areas of Monduli District, Tanzania sell their livestock to pay for watering charges. The study used a cross-sectional research design and gathered primary data through a semi-structured questionnaire from 367 randomly selected pastoralist households. Furthermore, triangulation was achieved by using focus group discussions and conducting interviews with key informants. The data was analyzed using SPSS for both descriptive (frequencies and percentages) and inferential statistics (binary logistic regression model). The binary logistic regression model was used to examine the determinants of the practice of selling livestock to pay watering charges by pastoralists. Content analysis was utilized to analyze the qualitative data. The findings show that the level of education (p=0.015); hiring of a tractor water bowser (p=0.002) and access to extension services (p=0.002) at p&lt;0.05 were positively significant determinants of selling livestock to pay watering charges for livestock by pastoralists. The study recommends that the Ministry of Agriculture, Livestock Departments, and Non-Governmental Organizations to work together to establish subsidies or financial assistance programmes for pastoralists in order to lower the cost of employing mechanized water delivery technologies such as tractor water bowser.

Does financial assistance reduce catastrophic spending for patients prescribed oral anti-cancer medications at an integrated Specialty Pharmacy?

27 Background: High copayments for oral anti-cancer medications (OAMs) can lead to detrimental financial and clinical outcomes for patients. Most patients insured by Medicare and prescribed an OAM reach the catastrophic phase of spending.1 Financial assistance programs are increasingly used to defray high out of pocket costs, though their ultimate impact on catastrophic spending has not been well-characterized. This study investigated whether receipt of financial assistance reduced likelihood of catastrophic spending for patients prescribed OAMs. Methods: This retrospective, single-institution, cross-sectional study included all patients prescribed an OAM with a &gt;$0 annual copay at an academic integrated Specialty Pharmacy between 1/1-12/31/2021. Data were sourced through a prescribing-level pharmacy database and through a third-party (Vivor/TailorMed) database. A fixed-effects linear regression model was used to identify the impact of financial assistance (binary predictor) on catastrophic spending (binary outcome), defined as spending above $4430/yr based on the average Medicare Part D threshold from 2022 to enter the catastrophic copayments phase. The model was adjusted for demographic and clinical covariates. Results: 1,186 patients were included in the analysis. Average annual copayment on OAMs was $862.50 (SD = $4,673.47) with 5.6% of patients faced catastrophic spending. 37% of patients received some form of financial assistance. Patients who received assistance had significantly lower annual spending on OAMs overall (ß= -$1236; 95% CI: -$1841-658, p&lt;0.001), but assistance was not associated with less catastrophic spending (OR=0.44; 95% CI: 0.14-1.38, p=0.16). Patients who were male, older, retired, insured by Medicare, and had higher annual household income by census tract were more likely to face catastrophic spending. Those who spoke English as a second language and lived in rural settings were less likely to face catastrophic spending. (Table). Conclusions: Financial assistance programs can decrease overall spending on OAMs but may not address financial burden for patients facing catastrophic level spending. Older adults with incomes too high to qualify for safety net or financial assistance programs may be at uniquely increased risk of catastrophic spending. Future studies should evaluate OAM-induced financial toxicity across diverse delivery systems and develop targeted interventions for patients who spend at catastrophic levels. [Table: see text]

Economic evaluation of a non-medical financial assistance program on missed treatment appointments among adults with cancer.

282 Background: Addressing patients’ cancer-related financial needs is critical to ensuring equitable cancer care delivery. Although many cancer centers report having financial support programs available to meet patients' medical and non-medical financial needs, formal evaluation of these programs has been limited. We retrospectively evaluated the impact of a program providing non-medical financial assistance on missed treatment appointments among patients receiving cancer treatment at a large, Southeastern public hospital system. Methods: We used patient electronic health records, program records, and cancer registry data to examine the impact of the program on rates of missed (or “no-show”) radiation therapy and infusion chemotherapy/immunotherapy appointments in the six months following treatment initiation. We employed propensity weighting to estimate the average treatment effect on those exposed to the program, stratified by treatment appointment type (radiation therapy, infusion chemotherapy/immunotherapy). We developed a decision tree-based economic model to assess the program’s cost-effectiveness from the health system perspective in a hypothetical cohort over a six-month time horizon. Results: Of 1,347 patients receiving radiation therapy between 2015 and 2019, 53% (N=715) had ≥1 no-shows, and 28% (N=378) received program assistance. Receipt of any assistance was associated with a 2.1 percentage point (95% CI: 0.6 – 3.5) decrease in the proportion of no-shows, corresponding to a 51% decrease in the overall mean no-show proportion. Under the current funding model, the program is estimated to save the health system $153 per missed appointment averted, relative to not providing non-medical financial assistance. Of the 1,641 patients receiving infusion chemotherapy/immunotherapy, 33% (N=541) received program assistance, and only 14% (N=223) had ≥1 no-shows. The financial assistance program did not have a significant effect on no-show proportions among infusion visits. Conclusions: This study employed a novel approach to retrospectively evaluate a non-medical financial assistance program for patients undergoing active cancer treatment. Findings support investment in programs that address patients’ non-medical financial needs, particularly for those undergoing intensive radiation therapy.

Economic Evaluation of a Nonmedical Financial Assistance Program on Missed Treatment Appointments Among Adults With Cancer.

We retrospectively evaluated the clinical and economic impact of a program providing nonmedical financial assistance on missed treatment appointments among patients receiving cancer treatment at a large, Southeastern public hospital system. We used patient electronic health records, program records, and cancer registry data to examine the impact of the program on rates of missed (or no-show) radiation therapy and infusion chemotherapy/immunotherapy appointments in the 180 days after treatment initiation. We used propensity weighting to estimate the effect of the program, stratified by treatment appointment type (radiation therapy, infusion chemotherapy/immunotherapy). We developed a decision tree-based economic model to conduct a cost-consequence analysis from the health system perspective in a hypothetical cohort over a 6-month time horizon. Of 1,347 patients receiving radiation therapy between 2015 and 2019, 53% (n = 715) had ≥1 no-shows and 28% (n = 378) received program assistance. Receipt of any assistance was associated with a 2.1 percentage point (95% CI, 0.6 to 3.5) decrease in the proportion of no-shows, corresponding to a 51% decrease in the overall mean no-show proportion. Under the current funding model, the program is estimated to save the health system $153 in US dollars per missed appointment averted, relative to not providing nonmedical financial assistance. Of the 1,641 patients receiving infusion chemotherapy/immunotherapy, 33% (n = 541) received program assistance, and only 14% (n = 223) had ≥1 no-shows. The financial assistance program did not have a significant effect on no-show proportions among infusion visits. This study used a novel approach to retrospectively evaluate a nonmedical financial assistance program for patients undergoing active cancer treatment. Findings support investment in programs that address patients' nonmedical financial needs, particularly for those undergoing intensive radiation therapy.