Monoclonal Antibodies in Cancer Care: Is Underinsurance An Access Barrier?

Summary

Principal Investigator: YA CHEN SHIH
Affiliation: The University of Texas
Country: USA
Abstract: DESCRIPTION (Provided by the Applicant): The high costs associated with several innovative cancer therapies, most notably monoclonal antibodies (mAbs), have raised a concern that even among cancer patients with insurance, mAbs may be financially unaffordable due to the associated high out-of-pocket payment. Such high costs create a vulnerable group of cancer patients known as the "under-insured." The objectives of our study are to use claims data to examine the diffusion of innovative monoclonal antibody agents among cancer patients younger than 65 years who have private insurance;to explore whether underinsurance may constitute a barrier to the access of these novel therapies;and to determine their impact on the costs of cancer care. The study has five specific aims: (1) to describe the trend of mAb use among non-elderly cancer patients with private insurance;(2) to examine whether mAb utilization patterns differ by patient characteristics and/or insurance generosity in the types of cancer with approved indication for mAb use;(3) to estimate the impact of mAbs on the costs of cancer care and cost increases over time in the types of cancer with approved indication for mAb use;(4) to determine factors associated with off-label mAb use;(5) to estimate the overall costs of cancer care and cost increases over time and to ascertain the associated cost drivers. For each study aim, appropriate econometric methods will be applied to analyze factors associated with mAb use, and cancer treatment costs. Separate analyses will be performed for all cancers, and for each of the three cancer sites that are most likely to be treated with mAbs: non-Hodgkin's lymphoma, colorectal cancer, and breast cancer. As immunotherapy, in particular, mAbs, becomes increasingly important in cancer care, this study will inform policymakers of the diffusion of recent therapeutic innovations among cancer patients and the impact of innovative agents such as mAbs on the costs of cancer care. This information will help project the future costs of cancer. Findings from this study will also alert policymakers to the subgroups of patients who may not benefit from innovative agents such as mAbs due to access barriers.
Funding Period: ----------------2009 - ---------------2013-
more information: NIH RePORT

Top Publications

  1. pmc First do no harm: population-based study shows non-evidence-based trastuzumab prescription may harm elderly women with breast cancer
    Ya Chen Tina Shih
    Section of Hospital Medicine, Department of Medicine, Program in the Economics of Cancer, The University of Chicago, 5841 S Maryland Avenue, MC 5000, 60637, Chicago, IL, USA
    Breast Cancer Res Treat 144:417-25. 2014
  2. doi A review of economic impact of targeted oral anticancer medications
    Chan Shen
    Departments of Health Services Research and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
    Expert Rev Pharmacoecon Outcomes Res 14:45-69. 2014
  3. pmc Factors contributing to underuse of radiation among younger women with breast cancer
    I Wen Pan
    Affiliations of authors Health Economics and Outcome Research, McKesson Specialty Health The Woodlands, TX I WP Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center Houston, TX BDS Section of Hospital Medicine, Department of Medicine, The University of Chicago Chicago, IL Y CTS
    J Natl Cancer Inst 106:djt340. 2014
  4. ncbi Population-based determinants of radical prostatectomy operative time
    Stacey C Carter
    Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
    BJU Int 113:E112-8. 2014
  5. pmc Nomogram to predict the benefit of radiation for older patients with breast cancer treated with conservative surgery
    Jeffrey M Albert
    The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
    J Clin Oncol 30:2837-43. 2012
  6. ncbi Infused chemotherapy use in the elderly after patent expiration
    Rena M Conti
    The University of Chicago, IL 60637, USA
    Am J Manag Care 18:e173-8. 2012
  7. pmc Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer
    Grace L Smith
    Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    JAMA 307:1827-37. 2012
  8. doi The association of the human development index with global kidney cancer incidence and mortality
    Amit R Patel
    Section of Urology and Department of Medicine, University of Chicago Hospitals, Chicago, Illinois 60637, USA
    J Urol 187:1978-83. 2012
  9. doi Comparative effectiveness, cost, and utilization of radical prostatectomy among young men within managed care insurance plans
    Ya Chen Tina Shih
    Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
    Value Health 15:367-75. 2012
  10. pmc Establishing common cost measures to evaluate the economic value of patient navigation programs
    Elizabeth Whitley
    Denver Health, Denver, CO, USA
    Cancer 117:3618-25. 2011

Scientific Experts

  • Benjamin D Smith
  • Ya Chen T Shih
  • I Wen Pan
  • Stacey C Carter
  • Chan Shen
  • Rena M Conti
  • Jeffrey M Albert
  • Grace L Smith
  • Sharon H Giordano
  • Amit R Patel
  • Thomas A Buchholz
  • Elizabeth Whitley
  • Stuart Lipsitz
  • Quoc Dien Trinh
  • Fabrice Smieliauskas
  • Paul L Nguyen
  • Daniel M Geynisman
  • Jim C Hu
  • Chun Ru Chien
  • Sandip M Prasad
  • Ying Xu
  • Blase N Polite
  • Yu Shen
  • Peter B Bach
  • Diane D Liu
  • Jing Jiang
  • Scott E Eggener
  • Karen E Hoffman
  • Meredith B Rosenthal
  • Taylor Teschner
  • Kristen Wells
  • Patricia Valverde
  • Loretta Williams

Detail Information

Publications13

  1. pmc First do no harm: population-based study shows non-evidence-based trastuzumab prescription may harm elderly women with breast cancer
    Ya Chen Tina Shih
    Section of Hospital Medicine, Department of Medicine, Program in the Economics of Cancer, The University of Chicago, 5841 S Maryland Avenue, MC 5000, 60637, Chicago, IL, USA
    Breast Cancer Res Treat 144:417-25. 2014
    ..Inappropriate prescriptions of targeted therapies agent can lead to detrimental health and financial consequences. ..
  2. doi A review of economic impact of targeted oral anticancer medications
    Chan Shen
    Departments of Health Services Research and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
    Expert Rev Pharmacoecon Outcomes Res 14:45-69. 2014
    ..Our review raises a concern regarding the role of sponsorship on findings of economic analyses as the vast majority of pharmaceutical company-sponsored studies reported cost advantages toward the sponsor's drugs. ..
  3. pmc Factors contributing to underuse of radiation among younger women with breast cancer
    I Wen Pan
    Affiliations of authors Health Economics and Outcome Research, McKesson Specialty Health The Woodlands, TX I WP Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center Houston, TX BDS Section of Hospital Medicine, Department of Medicine, The University of Chicago Chicago, IL Y CTS
    J Natl Cancer Inst 106:djt340. 2014
    ..However, women with young children may be less likely to be compliant. This study explores factors associated with noncompliance of RT among insured young patients...
  4. ncbi Population-based determinants of radical prostatectomy operative time
    Stacey C Carter
    Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
    BJU Int 113:E112-8. 2014
    ..To determine factors that influence radical prostatectomy (RP) operative times. Operative time assessment is inherent to defining surgeon learning curves and evaluating quality of care...
  5. pmc Nomogram to predict the benefit of radiation for older patients with breast cancer treated with conservative surgery
    Jeffrey M Albert
    The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
    J Clin Oncol 30:2837-43. 2012
    ..However, it is not known whether this recommendation should extend to other older women. Accordingly, we developed a nomogram to predict the likelihood of long-term breast preservation with and without RT...
  6. ncbi Infused chemotherapy use in the elderly after patent expiration
    Rena M Conti
    The University of Chicago, IL 60637, USA
    Am J Manag Care 18:e173-8. 2012
    ..The use of anticancer drugs (chemotherapies) is an important determinant of national spending trends. Recent policies have aimed to accelerate generic entry among chemotherapies to generate cost savings...
  7. pmc Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer
    Grace L Smith
    Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    JAMA 307:1827-37. 2012
    ..Because results of long-term randomized trials will not be reported for years, detailed analysis of clinical outcomes in a nonrandomized setting is warranted...
  8. doi The association of the human development index with global kidney cancer incidence and mortality
    Amit R Patel
    Section of Urology and Department of Medicine, University of Chicago Hospitals, Chicago, Illinois 60637, USA
    J Urol 187:1978-83. 2012
    ..We describe contemporary worldwide age standardized incidence and mortality rates for kidney cancer, and their association with social and economic development metrics...
  9. doi Comparative effectiveness, cost, and utilization of radical prostatectomy among young men within managed care insurance plans
    Ya Chen Tina Shih
    Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
    Value Health 15:367-75. 2012
    ..We compared utilization, clinical outcomes, and costs between two types of radical prostatectomy (RP)--minimally invasive prostatectomy (MIRP) and retropubic prostatectomy (RRP)--among young patients...
  10. pmc Establishing common cost measures to evaluate the economic value of patient navigation programs
    Elizabeth Whitley
    Denver Health, Denver, CO, USA
    Cancer 117:3618-25. 2011
    ..Despite the proliferation of patient navigation programs across the United States, information related to the economic impact and sustainability of these programs is lacking...
  11. doi Adoption of intensity-modulated radiation therapy for breast cancer in the United States
    Benjamin D Smith
    Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1202, Houston, TX 77030, USA
    J Natl Cancer Inst 103:798-809. 2011
    ..It is thus controversial whether such treatment justifies billing for intensity-modulated radiation therapy (IMRT)...
  12. doi Economic burden of renal cell carcinoma in the US: Part II--an updated analysis
    Ya Chen T Shih
    Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    Pharmacoeconomics 29:331-41. 2011
    ..Following an updated review of RCC-related economic studies, we supplemented the costs of RCC reported in the literature with estimates from the latest US databases that capture the utilization of several newly approved targeted agents...
  13. doi Economic burden of renal cell carcinoma: Part I--an updated review
    Ya Chen T Shih
    Section of Health Services Research, Department of Biostatistics, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    Pharmacoeconomics 29:315-29. 2011
    ..More research is needed to assess the quality of the economic studies of RCC and to understand why the estimated costs differ across studies...