Prescription Drug Costs Research Articles

Medical Care Costs Associated with Cancer Survivorship in the United States.

The prevalence of cancer survivorship is increasing. In this study, we provide contemporary population-based estimates and projections of the overall and site-specific cancer-attributable medical care costs in the United States. We identified survivors aged ≥65 years diagnosed with cancer between 2000 and 2012 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and used 2007 to 2013 claims to estimate costs by cancer site, phases of care, and stage at diagnosis. Annualized average cancer-attributable costs for medical care (Medicare Parts A and B) and oral prescription drugs (Medicare Part D) were estimated by subtracting costs between patients with cancer and matched controls. Costs are reported in 2019 U.S. dollars. We combined phase-specific attributable costs with prevalence projections to estimate national costs from 2015 through 2030. Overall annualized average costs were highest in the end-of-life-cancer death phase, followed by the initial and continuing phases (medical care: $105,500, $41,800, and $5,300 and oral prescription drugs: $4,200, $1,800, $1,100, respectively). There was considerable variation in costs by cancer site and stage. Overall national costs in 2015 were $183 billion and projected to increase 34% to $246 billion by 2030, based only on population growth. Phase of care cancer-attributable cost estimates by cancer site and stage are key inputs for simulation models and cost-effectiveness analyses. The national cancer-attributed medical care costs in the United States are substantial and projected to increase dramatically by 2030, due to population changes alone, reflecting the rising burden of cancer care among cancer survivors.

Panel-based methodology for assessing the impact of public policies on cancer patients and survivors.

12059 Background: Cancer interventions are subject to a range of regulations, but data from large, nationally representative surveys are not always available in time to inform the policy process and do not always address issues specific to cancer patients and survivors. Understanding their experiences is critical to achieving policy solutions to issues such as access to effective pain relief, reducing unexpected medical bills, and reducing the impact of high prescription drug costs on treatment for lower income cancer patients. This research intended to better understand patient experiences and opinions in a statistically valid manner specifically targeted to the policy process. Methods: 3057 panelists were identified from ACS contacts, health systems, and social media advertising through ACS/ACS CAN pages and paid Facebook ads, to participate in a series of surveys across a year. The panel included diverse survivors across age, gender, race, ethnicity, economic status, and cancer type. Online surveys deployed semi-monthly on cancer survivorship topics impacted by current policy, including access to/affordability of care, pain treatment, and prescription drug costs. Responses were analyzed for the entire population and across subgroups of cancer survivors. Results: Each survey achieved a response rate between 35% and 50% of all panel members, resulting in a margin of error +/- 3% and 95% confidence level. Insights from cancer patient and survivor experiences helped support public policies through findings such as (but not limited to): 41% of those prescribed opioids had trouble getting their medicine, creating difficulty participating in work, family, or social events; extra trips to the doctor or pharmacy; negative impact on treatment, and trips to the Emergency Room due to uncontrolled pain; 24% received a surprise medical bill, increasing their anxiety, reducing likelihood to see a specialist, and reducing likelihood to seek emergency care during a serious health issue; and 31% of those with household income less than $30,000 report trouble affording prescription drugs and 17% have delayed or not filled a prescription due to cost. Findings supported the policy process by helping craft policy positions aligned with cancer patient preferences, raising public awareness, and communicating to policymakers the impact of policies on cancer. Conclusions: The panel methodology illustrates the impact of policy decisions on cancer patients and survivors. Findings provide an unprecedented level of input to the policy process for cancer patients and survivors.

PMH47 INTEGRATED PHARMACY BENEFITS ARE ASSOCIATED WITH REDUCED TOTAL MEDICAL SPENDING FOR MEMBERS WITH MENTAL HEALTH CONDITIONS: A BCBSLA PERSPECTIVE

While pharmacy benefit carve-outs are promoted as a cost-containment tool, their impact on total medical spending is not well understood. We compare the healthcare spending of Blue Cross Blue Shield of Louisiana members with mental health conditions covered by an integrated (“carved-in”) pharmacy benefit with members covered under a pharmacy benefit carve-out. The study population included all Blue Cross members with continuous medical coverage from October 1, 2014 to September 30, 2018 with a diagnosis of one of the following mental health diseases: Depression, Anxiety Disorders, or Other Mental Health Diagnosis. Participants were primary members whereby their companies contracted Administrative Services Only (ASO) through Blue Cross. Additional inclusion were that members had to be continuously enrolled for four consecutive years in either a Carve-In or Carve-Out program. Outcomes of interest include: per member per month (PMPM) annual expenditures, emergency room visits and inpatient hospitalizations. Carve-Out mental health patients were 1:1 exact matched to Carve-In patients based on member demographics (gender, region), chronic comorbidities (Asthma, Diabetes), program participation (CMDM, Quality Blue, Product Network) and annual risk severity category (Healthy, Stable, At Risk, Struggling, In Crisis). After exact matching our final sample was 20,485 members. Of which, 3,944 (19%) members were identified to have a mental health condition. These members accounted for about one-third of the total cost in the first year of the study (32% vs 33%). Findings show average annual costs consistently increase year over year for the Carve-Out patients (difference >$33.12 PMPM) with mental health conditions versus those in the Carve-In program. Members with mental health conditions receiving an integrated pharmacy benefit experienced slower medical cost growth compared to members covered by a pharmacy carve-out. Managers may want to consider the implications of pharmacy benefit design for total cost of care, not just prescription drug costs.

PNS70 US “IMPORT-FROM-CANADA” DRUG LEGISLATION: WILL IT LOWER DRUG COSTS FOR AMERICAN CONSUMERS?

To address high prescription drug costs, the United States (US) has proposed parallel importation of patented drugs from Canada, which are sold at lower costs. The objective of this review is to assess the implications of the proposed US “import-from-Canada” legislation, using both prior Canada-US and European Union (EU) parallel trade examples. A targeted literature review (TLR) was conducted in relevant databases (EMBASE, Medline, Cochrane, PubMED, PAIS Index, and CINAHL) to identify articles relating to Canada-US parallel trade within the last 20 years (supplemented by a hand-search for EU examples). Overall, 489 articles were identified from the primary search related to Canada-US parallel trade of drugs, leading to 13 articles for analysis after title-abstract and full-text reviews. This search was supplemented by 40 articles related to EU parallel trade through hand-searching. The articles were extracted for: countries involved, relevant legislation/policies, and key findings (e.g. net policy benefits/harms, supporting evidence, etc.) using SWOT framework for analysis. It is important to note that most literature (62%) on this topic was based on opinions versus qualitative or quantitative evidence. Few articles (n=4) reported hypothesized benefits of parallel trade. Claimed benefits included: lowered drug costs, rise in virtual pharmacies, and diminished price-differentiated markets. However, several articles (n=9) identified negative factors, such as: unsustainability of reduced drug prices, threat in profitability of US pharmaceutical companies, arbitragers gaining profit (i.e. insignificant consumer savings), limited drug supply, and increased counterfeit drugs. This is reflective of outcomes observed in the EU, where parallel trade resulted in high profits for arbitragers and drug shortages in source countries. Parallel trade from Canada is unlikely to result in lowered drug costs to American consumers. As Canada implements new dramatic drug price controls (i.e. Patented Medicine Prices Review Board [PMPRB]), manufacturer response to the US legislation may be exacerbated.

PNS94 2018 AND 2019 OUTCOMES BASED CONTRACTING TRENDS EXPLORED BY TA, PAYER TYPE AND RISK SHARING MECHANISM IN THE US

As prescription drug costs continue to rise, health insurers in the US struggle to implement novel pricing approaches to enable affordable access to innovative therapies. Value based risk-sharing agreements are growing in popularity among US health insurers as payers attempt to find a strategy to provide the most cost-effective solution in return for maximum quality and clinical benefit. Given the complexity and feasibility of these agreements, variation exists among the types of contracts and components health insurers consider implementing. This abstract assesses the contracting elements adopted by US health plans, integrated delivery networks (IDNs) and pharmacy benefit managers (PBMs) in outcomes-based contracting (OBC). We assessed all publicly available OBCs. The OBCs assessed were between pharmaceutical manufacturers and payers in the US, and the analysis focused on deals from 2018/2019, with sub-analysis from 2016/2017. This analysis reviewed 53 agreements implemented by 20 health insurers and 20 manufacturers. The most common contracts in the US were for metabolic and CNS indications. Regional health insurance plans were participants in the most publicly available contracts (52%), followed by PBMs (21%). This varied when compared to contracts initiated in 2016/2017, where new deals were led by IDNs and national healthcare insurers. Additionally, majority of contracts were payment by result agreements (79%), and regional plans were the only payers to adopt subscription-based agreements. While the structure of the deals were disclosed in this limited sample, the results and impact were largely not. Findings demonstrate a continued, and likely expanding use of OBCs to drive coverage of, access to, and affordability for innovative therapies. However, lack of transparency of the deals leads to limited knowledge of their value and how widespread their use is. As the industry increasingly leverages OBCs, more work is needed to understand their comparative impact and what types of deals are performing best.

PNS86 HOW TO THINK ABOUT VALUE ASSESSMENT OF MEDICAL SERVICES IN THE UNITED STATES

U.S. spending on healthcare is the highest in the world and there is little understanding of the value for that spending. While prescription drug costs receive considerable scrutiny through economic evaluation and policy attention, relatively less discussion is focused on medical services, which account for the majority of U.S. healthcare spending. In addition, medical procedures are rarely subject to regulatory review of economic value. This study aims to provide an organizing structure to consider the value of medical services. A targeted literature review was conducted to develop a framework synthesizing findings regarding the economic value of medical services, and identify areas where value assessment of medical services could be most RESU The framework separates the value assessment of medical services into two dimensions: utilization and pricing; utilization takes prices as given and considers appropriate levels of use, while pricing focuses on variation in prices for a given procedure at existing utilization levels. Utilization assessments lend themselves to two measures of value. First, while many medical services may be cost-effective on average, multiple studies suggest that some services do not meet standard cost-effectiveness thresholds among certain well-defined patient subsets. This may be either due to lack of efficacy, or availability of lower cost alternatives with similar efficacy. Second, overutilization of services may provide no clinical value, or even negative value, at higher costs. Notable examples include certain diagnostic or screening technologies. Price variation – within and across geographic units – can reflect different market conditions, but can be partially attributed to provider market power and a lack of price transparency. Both suggest that savings could be achieved without reduction in quality of care. The presented framework can assist in organizing the disparate literature on the value of medical services, and highlights key areas of consideration for future research.

PMH7 ECONOMIC BURDEN OF TREATMENT-RESISTANT DEPRESSION AMONG ADULTS WITH CHRONIC NON-CANCER PAIN CONDITIONS AND MAJOR DEPRESSIVE DISORDER

Chronic non-cancer pain conditions (CNPC) and Major Depressive Disorder (MDD) often co-occur and presents a substantial economic burden. Treatment-resistant depression (TRD) in adults with CNPC can amplify the economic burden. This study examined the impact of TRD on total and MDD-related healthcare resource utilization (HRU) and costs among patients with CNPC and MDD. The study used a retrospective longitudinal cohort design and employed a claims-based algorithm to identify adults with TRD from a US claims database (January 2007- June 2017). Costs and HRU were measured over a 12-month period after TRD/non-TRD index date. Counterfactual recycled predictions from generalized linear models were used to examine associations between TRD and annual HRU and costs. Post-regression linear decomposition identified differences in patient-level factors between TRD and non-TRD groups that contributed to the excess economic burden of TRD. Of the 21,180 adults with CNPC and MDD (mean age 55 years, 74% females, 33% had ≥3 CNPC), 10.1% were identified as having TRD. TRD patients had significantly higher HRU, translating into higher average total costs ($21,015TRD vs $14,712No TRD) and MDD-related costs ($1,201TRD vs $471No TRD) compared to non-TRD patients (all P <0.001). Prescription drug costs accounted for 37.6% and inpatient services for 30.7% of the excess total healthcare costs among TRD patients. TRD patients had significantly higher number of inpatient visits (IRR = 1.30, 95% CI = 1.14-1.47) and emergency room visits (IRR = 1.21, 95% CI = 1.10-1.34) than non-TRD patients. Overall, 46% of the excess total costs were explained by differences in patient level characteristics such as polypharmacy, number of CNPC, anxiety, sleep, and substance use disorders between the TRD and non-TRD groups. TRD poses a significant direct economic burden among adults with CNPC and MDD. Excess healthcare costs may potentially be reduced by providing timely interventions for several modifiable risk factors.

PCN259 USING LONGITUDINAL PATIENT LEVEL DATA TO ASSESS THE VALUE OF NEW PANCREATIC CANCER TREATMENTS ON TOTAL HEALTH SPENDING

Health technology assessment programs are increasingly using longitudinal, patient-level data to assess the effect of new medicines on total cost of care. We analyzed such data to measure the impact of new pancreatic cancer therapies on other, non-drug medical expenditures. The latest update of the MEPS data, including the 21 Longitudinal Data Files which track subjects across the 5 rounds of interviews over 2 years, were obtained. The Medical Conditions File was used to identify all patients who were diagnosed with a cancer of the pancreas, including International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 157.0, 157.1, 157.2, 157.3, 157.4, 157.8, 157.9. Included subjects (N = 80) had a diagnosis of pancreatic cancer and available prescription data. Individual age, type of insurance coverage, and employment status were accounted for as covariates. All analyses were performed using R version 3.6.1 on Ubuntu 19.04. Means and standard deviations were computed for the raw and inflation-adjusted total health care costs (excluding drug spending). Prescription drug costs for the period between 2009-2016 to include approval and use of (nab)-paclitaxel and erlotinib were also obtained and adjusted for inflation. The prescription drug expenses and proportion of healthcare spending were plotted along with a LOESS curve using the same parameters. Between 2009 and 2016, inflation-adjusted per patient spending on pancreatic cancer care declined from $37,500 to $10,000, respectively. Prescription drug spending increased during the same time period from $2,100 to $6,100 per person (inflation-adjusted). In effect, for every additional dollar spent on drugs for pancreatic cancer in 2016, there was a reduction in non-drug spending of $9. Analysis of longitudinal, patient-level, real-world data provides a dynamic assessment of the impact of new medicines on well-being and medical utilization in those with pancreatic cancers.

Investigation of injectable drug utilization in primary care: A focus on different age groups in pediatric population

ObjectiveThe suitability of the injectables may vary across different age groups especially for children; therefore, knowledge on their usage patterns is critical in terms of rational pharmacotherapy. This study aimed to investigate pediatric injectable drug utilization in primary care with a focus on different age groups. MethodBy simple sampling method, 100 prescriptions that contained at least one injectable drug were randomly selected for each month of the year in 32 provinces of Turkey (n=38.400). Among these prescriptions, injectable drugs that were for children (<18 years) were analyzed. Patterns of injectable drug utilization were compared according to the pediatric age group of “infants”, “children”, and “adolescents”. ResultsWe identified 5446 patients (14.2%) with a mean age of 7.4±5.2 years and a slight male tendency in distribution (53.8%). The most common indication for these patients was for the respiratory system (65.4%), of which 96.3% were respiratory tract infections. While less pronounced in adolescents than in infants and children, the most commonly prescribed injectable drugs were antibiotics in all age groups (61.5% vs. 78.6% and 79.9%, P<0.0001), which was upheld across all seasons. More than 90% of all prescribed injectable antibiotics consisted of penicillins and cephalosporins; the latter being predominant in infants (67.4%) compared with penicillins in children (53.9%) and adolescents (59.0%). Analgesics and insulin were found to be prescribed more frequently to adolescents than they were to infants and children (P<0.0001 and P<0.0001, respectively). The mean cost of prescription and injectable drugs per encounter was significantly more likely to escalate with increasing age (P<0.0001 and P<0.0001, respectively). ConclusionConsidering the predominance of antibiotics as well as the substantially higher prescription of third-generation cephalosporins in primary care, which was especially more marked for younger children, our study indicates an inappropriate use of injectable drugs by primary care physicians for managing medical conditions in the pediatric population.

Stemming the Escalating Costs of Prescription Drugs.

Stemming the Escalating Costs of Prescription Drugs.

Level of self-reported pain’s interference with work, and association with number of prescriptions and healthcare expenditures

Abstract Objectives To examine the associations between pain interfering with work and family income and health status and to quantify the impact of pain on pharmaceutical utilization and cost using data from the Medical Expenditure Panel Survey (MEPS). Methods The study population included adult respondents to a MEPS pain question asking how much pain interfered with normal work (including both work outside the home and housework) from 2007 to 2014 (n = 71 593 respondents). Generalized linear models estimated the association between pain and family income, self-reported health status, number of prescriptions and healthcare expenditures (prescription drug and total). Control variables included age, gender, education, marital status, poverty, race, immigration status, region, obesity, work status and insurance coverage. Key findings Nearly 43% of respondents reported pain did not interfere at all with their work, 32% responded it did ‘a little bit’, 14% said ‘moderately’, 8% reported ‘quite a bit’, and 3% said ‘extremely’. Older respondents were significantly more likely to report pain interfering with work than younger ones. Women were more likely than men to report pain interfering with work. Obesity was significantly associated with pain, with 5.3% of obese respondents stating pain extremely interfered with work compared to 2.2% of nonobese respondents. Those who reported pain interfered ‘extremely’ had, on average, 46 prescriptions filled per year compared to only 5 prescriptions for those reporting less severe pain. This translated into significantly higher prescription drug and total costs. Conclusion Innovative targeted interventions are needed to mitigate the severe consequences of pain on health, well-being and cost.

Demystifying pharmaceutical patient assistance programs

Prescription drug costs impose a significant financial burden on the United States healthcare system. Patients with chronic dermatologic diseases often require long-term and expensive prescription drugs. In an effort to expand drug availability, pharmaceutical companies fund patient assistance programs (PAPs) to assist disadvantaged patients in gaining access to high-priced brand name medications with no suitable therapeutic alternative. Patients and clinical staff often face difficulty navigating the various PAPs. Herein, we seek to explore the utility, criteria, and challenges in PAPs and provide a practical discourse for dermatologists caring for medically indigent patients.

Impact of socioeconomic status on end-of-life costs: a systematic review and meta-analysis

BackgroundSocioeconomic inequalities in access to, and utilization of medical care have been shown in many jurisdictions. However, the extent to which they exist at end-of-life (EOL) remains unclear.MethodsStudies in MEDLINE, EMBASE, CINAHL, ProQuest, Web of Science, Web of Knowledge, and OpenGrey databases were searched through December 2019 with hand-searching of in-text citations. No publication date or language limitations were set. Studies assessing SES (e.g. income) in adults, correlated to EOL costs in last year(s) or month(s) of life were selected. Two independent reviewers performed data abstraction and quality assessment, with inconsistencies resolved by consensus.ResultsA total of twenty articles met eligibility criteria. Two meta-analyses were performed on studies that examined total costs in last year of life – the first examined costs without adjustments for confounders (n = 4), the second examined costs that adjusted for confounders, including comorbidities (n = 2). Among studies which did not adjust for comorbidities, SES was positively correlated with EOL costs (standardized mean difference, 0.13 [95% confidence interval, 0.03 to 0.24]). However, among studies adjusting for comorbidities, SES was inversely correlated with EOL expenditures (regression coefficient, −$150.94 [95% confidence interval, −$177.69 to -$124.19], 2015 United States Dollars (USD)). Higher ambulatory care and drug expenditure were consistently found among higher SES patients irrespective of whether or not comorbidity adjustment was employed.ConclusionOverall, an inequality leading to higher end-of-life expenditure for higher SES patients existed to varying extents, even within countries providing universal health care, with greatest differences seen for outpatient and prescription drug costs. The magnitude and directionality of the relationship in part depended on whether comorbidity risk-adjustment methodology was employed.

Design and rationale of a multi-center, pragmatic, open-label randomized trial of antimicrobial therapy \u2013 the study of clinical efficacy of antimicrobial therapy strategy using pragmatic design in Idiopathic Pulmonary Fibrosis (CleanUP-IPF) clinical trial

Compelling data have linked disease progression in patients with idiopathic pulmonary fibrosis (IPF) with lung dysbiosis and the resulting dysregulated local and systemic immune response. Moreover, prior therapeutic trials have suggested improved outcomes in these patients treated with either sulfamethoxazole/ trimethoprim or doxycycline. These trials have been limited by methodological concerns. This trial addresses the primary hypothesis that long-term treatment with antimicrobial therapy increases the time-to-event endpoint of respiratory hospitalization or all-cause mortality compared to usual care treatment in patients with IPF. We invoke numerous innovative features to achieve this goal, including: 1) utilizing a pragmatic randomized trial design; 2) collecting targeted biological samples to allow future exploration of ‘personalized’ therapy; and 3) developing a strong partnership between the NHLBI, a broad range of investigators, industry, and philanthropic organizations. The trial will randomize approximately 500 individuals in a 1:1 ratio to either antimicrobial therapy or usual care. The site principal investigator will declare their preferred initial antimicrobial treatment strategy (trimethoprim 160 mg/ sulfamethoxazole 800 mg twice a day plus folic acid 5 mg daily or doxycycline 100 mg once daily if body weight is < 50 kg or 100 mg twice daily if ≥50 kg) for the participant prior to randomization. Participants randomized to antimicrobial therapy will receive a voucher to help cover the additional prescription drug costs. Additionally, those participants will have 4–5 scheduled blood draws over the initial 24 months of therapy for safety monitoring. Blood sampling for DNA sequencing and genome wide transcriptomics will be collected before therapy. Blood sampling for transcriptomics and oral and fecal swabs for determination of the microbiome communities will be collected before and after study completion. As a pragmatic study, participants in both treatment arms will have limited in-person visits with the enrolling clinical center. Visits are limited to assessments of lung function and other clinical parameters at time points prior to randomization and at months 12, 24, and 36. All participants will be followed until the study completion for the assessment of clinical endpoints related to hospitalization and mortality events.Trial RegistrationClinicalTrials.gov identifier NCT02759120.

Regulating Conflicts of Interest Through Public Disclosure: Evidence From a Physician Payments Sunshine Law

Hospital and health care administrators have often named prescription drug costs as one of their largest cost problems. Relatedly, a significant body of research demonstrates that meals and honoraria from pharmaceutical firms to physicians leads to higher prescribing of expensive, brand name drugs. Some administrators and scholars have advocated for mandatory disclosure of these payments in order to reduce this conflict of interest, but many practitioners believe disclosure has little effect on prescribing. This paper uses a quasi-experiment of a 2009 payment disclosure policy in Massachusetts to estimate the causal impact of public disclosure on prescribing. The comprehensive dataset includes all retail prescriptions for 262 drugs in 9 drug classes written by 5730 physicians in five states over 48 months. We show a significant post-disclosure reduction in brand name drug prescriptions by Massachusetts physicians, relative to control doctors in other states. These effects are driven by heavy prescribers of brand name drugs in the pre-policy period, particularly for drugs with large pre-policy sales forces. Effects are also detected before the first data were released, implying that the effects are not because patients or administrators responded to the disclosed payments. Instead, some physicians may have reduced payments after disclosure is mandated, leading to changes in their prescriptions. Taken in tandem with the many studies showing that industry payments influence prescribing, this study suggests a strong role for mandatory public disclosure in reducing conflicts of interest in medicine and costly prescribing of brand name drugs.

The relationship between the number of available therapeutic options and government payer (medicare part D) spending on topical drug products.

The cost of prescription drugs has increased at rates far exceeding general inflation in recent history, with topical drugs increasing at a disproportionate rate compared to other routes of administration. We assessed the relationship between net changes in the number of therapeutic options, defined as any approved drug or therapeutic equivalent on the market, and prescription topical drug spending. Drugs were divided based on the category of use through pairing of Medicare Part D Prescriber Public Use and Food and Drug Administration (FDA) approved drug products databases. Across drug classes, we modeled the log of the ratio of total spending per unit in 2015 to total spending per unit in 2011 as a linear function of net number of topical therapeutic options over this time period. Primary outcomes include total Medicaid Part D spending on topical drugs and net change in the number of available therapeutic options within each category of use. Total spending on topical drugs increased by 61%, while the number of units dispensed increased by only 18% from 2011-2015. The greatest total spending increases were in categories with few new therapeutic options, such as topical corticosteroid and antifungal medications. Each net additional therapeutic option during 2011-2015 was associated with an reduction in how much relative spending per unit increased (95% CI 2.5%-14.4%, p = 0.013). Stimulating greater competition through increasing the net number of therapeutic options within each major topical category of use may place downward pressure on topical prescription drug spending under medicare Part D.

An assessment of the total cost of pancreatic cancer using real-world evidence.

773 Background: The aggregate health economic implications of pancreatic cancer are poorly understood, especially from the patient perspective. As a preliminary effort, we sought to better understand changes in type and quantity of medical expenditures over time, along with quality of life related costs, from this perspective. This preliminary research is part of a larger effort to understand how the introduction of new treatments affect both the outcome and costs of pancreatic cancer associated with care, patients, survivors, their families, and their communities. Methods: We analyzed patient-level data from the Medical Expenditure Panel Survey (MEPS, 1996- 2017). All analyses were performed using R version 3.6.1 on Ubuntu 19.04. Averages were computed for the total health care costs, including prescription drug costs. Average individual annual cost estimates for the second year excluded individuals that were identified as having died prior to the first round of data collection in the second year. The individual patient level ratios of prescription drug cost to other medical expenses was also computed. All expenditures are adjusted for inflation using 2017 US dollars. Included subjects, N= 80 had a diagnosis of pancreatic cancer and available prescription data. Individual age and employment status were accounted for as covariates. Results: Between 1997 and 2017 inflation adjusted first and second year non-medication spending on pancreatic cancer care averaged $66,999.96 and $105,308.60 respectively. However, inflation-adjusted first and second year charges for hospitalizations and emergency visits fell between 2007-2017. Prescription drug as a proportion of total spending prescription drugs increased during the same time period. Lost work/school days declined between 2007 and 2017. Conclusions: Total inflation adjusted pancreatic cancer care expenses declined over the past decade even as drug costs increased. Quality of life costs declined as well. Further analysis is needed to evaluate the relationship between drug spending, total cost of care and quality of life.

Revisiting the National Institutes of Health Fair Pricing Condition: Promoting the Affordability of Drugs Developed With Government Support.

The high cost of many prescription drugs has renewed calls for policies to ensure that taxpayers' financial contributions to drug development are factored into price setting. The authors discuss le...

The High Cost of Insulin in the United States: An Urgent Call to Action

The High Cost of Insulin in the United States: An Urgent Call to Action

Prescription drug costs contribute to antiretroviral nonadherence

Prescription drug costs contribute to antiretroviral nonadherence