Wastage of oral cancer drugs due to dose modifications or discontinuations resulted in a mean cost of $4290 per patient in a study published in JAMA Oncology.1
Researchers conducted this study to estimate the cost of pill wastage for 22 oral cancer drugs that were approved by the US Food and Drug Administration between 2020 and 2022.
The researchers used the Micromedix RED BOOK database to determine the monthly cost of each drug. They used the package insert and/or the published literature to identify registration trials.
A total of 35 trials were included in the analysis, as some of the 22 drugs had multiple indications. The most common drug targets were PARP (n=7) and EGFR (n=4), and the most common indications were non-small cell lung cancer (n=9) and breast cancer (n=4).
Dose reductions occurred in 24% of cases, and discontinuations occurred in 10%.
There were 8 drugs approved for 9 indications that offered pill strengths divisible by the level of dose reduction, making the cost of a dose reduction $0. In addition, dose reductions were not allowed for 2 of the drugs studied.
Overall, the median cost of dose reductions was $654,291, and the median cost of discontinuations was $184,452. The median cost of wastage due to dose reduction or discontinuation was $1751, and the mean cost of wastage per patient was $4290.
The drug with the highest cost of wastage was avapritinib, at $27,200 per patient when the drug was used to treat advanced systemic mastocytosis. The researchers noted that this was a result of the high cost per bottle, multiple dose reduction levels at each pill strength, and the frequency of dose reductions.
The lowest cost of wastage was $43 for relugolix for advanced prostate cancer. Dose reduction was not allowed, so the entire cost came from discontinuations.
“These results suggest that, to reduce the financial burden for patients with cancer, regulatory bodies should enforce availability of pill strengths that will limit pill wastage during dose modification or recommend that drug manufacturers issue credit for unused pills,” the researchers wrote.
Authors of a related editorial noted that “the fundamental issue is high prescription drug prices,” which are “especially problematic for oral anticancer medications because prices of these agents have grown at a faster pace than their infused counterparts.”2
“Ideally, drug developers, clinicians, insurers, alongside policymakers and regulators would collaborate on the important problem of oncology drug pricing to develop agreed on solutions that maximize patient well being and minimize waste and financial burden,” the editorialists wrote.
Originally Posted in Cancer Therapy Advisor.
