Abstract 180P
Background
Out-of-pocket (OOP) cost is considered a possible barrier to treatment persistence among breast cancer (BC) patients. The SLR aimed to examine the association between OOP cost and treatment persistence among women with BC in the United States (US).
Methods
EMBASE® and MEDLINE® were searched to identify US-based studies published between 2011-2022. The SLR followed a standard two review and quality control process for data collection and extractions.
Results
Across the 351 citations retrieved, a total of five studies reporting the association between OOP cost and persistence among BC patients met the inclusion criteria. The sample size ranged from 197 to 25,511. Four studies defined persistence as medication dispensing without a gap of ≥90 days, while in one study non-persistence (discontinuation) was defined as a prescription supply gap of ≥45 days without subsequent refill. Four studies reported a negative association between OOP cost and early-stage BC (ESBC) treatment persistence, i.e., persistence decreases with an increase in OOP cost. An increase in OOP cost from $0-$29.99 to ≥$90/month resulted in a significant reduction in the persistence to adjuvant hormonal therapy (AHT) among elderly women (OR 0.82). Another study reported a significant association between increasing AHT-specific OOP cost and non-persistence (p<0.0001). Similarly, ESBC White, Black, and Hispanic patients (aged 65+ years) with OOP support through Medicare Part D Low-Income Subsidy reported significantly lower discontinuations compared to respective unsubsidized groups (p<0.001). Further, a statistically significant increase in trastuzumab non-persistence (discontinuation) was reported with higher OOP cost among the metastatic BC (mBC) patients (HR vs. ≤$500: 1.62 for $2001-$4000; 1.88 for >$4000).
Conclusions
The finding of SLR highlight a significant burden of OOP costs and/or co-payments leading to non-persistence among BC patients. A reduction in OOP costs or subsidized OOPs may have a positive impact on persistence and survival outcomes among ESBC or mBC patients. The SLR advocates the need for further research on the impact of OOP cost on persistence and survival among BC patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.