Polypharmacy and out-of-pocket medication costs in the last month of life among commercially insured patients with advanced cancer: Insights from linking a regional cancer registry and insurance claims.
McDermott, CL; Fedorenko, CR; Greenwood-Hickman, MA; Kreizenbeck, KL; Conklin, T; Smith, B; Curtis, JR; Lyman, GH; Ramsey, SD
Published in: Journal of Clinical Oncology
79 Background: Polypharmacy, defined as the concurrent use of multiple medications, may expose patients to drug-drug interactions and excessive medication costs. Patients with advanced cancer may benefit from medication discontinuation when faced with life-limiting illness. While polypharmacy prevalence has been explored in older patients, there are limited data for younger patients with advanced malignancy. To better understand medication use in this population, we characterized medication use and associated out-of-pocket (OOP) costs in the last month of life among commercially insured subjects under age 65 who did not enroll in hospice. Methods: We linked enrollment and claims records from two regional commercial insurers to Surveillance, Epidemiology, and End Results (SEER) Cancer Surveillance System and Washington State Cancer Registry records for patients diagnosed with a stage IV solid tumor malignancy in Washington state between January 1, 2007-December 31, 2016. We excluded patients who did not incur at least 1 claim in their last month. We calculated OOP costs as the difference between allowed and paid claim amounts, adjusted to 2016 dollars. Results: See Table. Among 369 patients, the average age was 56 years (range 23-64) and 51% (n=189) were male. Patients most frequently had lung (n=149, 40%), pancreatic (n=36, 10%) or colorectal cancer (n=32, 9%). Patients had an average of 7 medication claims (range 1-26) in the last month of life; the most commonly observed non-chemotherapy claims were for opioids, benzodiazepines and anti-emetics. Conclusions: A majority of subjects incurred at least 5 medication claims in their last 30 days; almost one-third had 10 or more. Frequent claims were for medication for pain or other symptoms. OOP costs ranged considerably. Future research will focus on developing interventions to assure effective medication use congruent with patient and family preferences and goals of care. [Table: see text]
