Physician dispensing of oral specialty drugs for advanced prostate cancer and its implications for patients

医生对晚期前列腺癌口服专科药物的配药及其对患者的影响

基本信息

批准号：
10862259
负责人：
BRENT K. HOLLENBECK
金额：
$ 53.09万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-02-01 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10862259
关键词：
Adherence Adoption Adverse drug effect Adverse event Authorization documentation Behavior Cancer Etiology Cessation of life Classification Coping Behavior Data Development Disease Drug Costs Drug Targeting Eligibility Determination Familiarity Financial Hardship Financial Support Fostering Heterogeneity Home Improve Access Incentives Malignant neoplasm of prostate Measures Medical Medical Oncologist Medical Oncology Medicare Modeling Oral Outcome Patients Pharmaceutical Preparations Pharmacy facility Phase Physicians Population Prednisone Price Recommendation Risk Safety Secure System Time Toxic effect Underrepresented Populations Urologist Urology Work abiraterone advanced prostate cancer authority black men cancer care chemotherapy cost enzalutamide financial incentive improved interest medical specialties medication compliance men mortality patient safety point of care targeted treatment therapy duration trend

项目摘要

PROJECT SUMMARY Nearly 35,000 succumb to advanced prostate cancer each year, making it the second leading cause of cancer death among men. The development of oral specialty drugs targeting specific molecules has led to a paradigm shift in which men can receive treatment for their prostate cancer at home. Oral specialty drugs, such as abiraterone and enzalutamide, have similar efficacy as physician administered chemotherapy with less toxicity and are the most common first-line treatment for advanced prostate cancer as of 2015. This new treatment paradigm has been accompanied by concurrent changes in in the delivery system. Increasingly, prescriptions for oral specialty drugs are dispensed directly by the urologist or medical oncologist in their office (referred to as “physician dispensing”). Patients may benefit from this delivery model as it places the onus for authorization and identification of financial assistance on the prescribing physician. Combined with the integration and coordination implied by dispensing at the point of care, this delivery model may improve access, timeliness and adherence to these specialty drugs. However, financial incentives associated with physician dispensing, through a margin generated by each prescription fill, may foster prescribing behaviors promoting utilization that undermine the value of this delivery system change, such as use of these therapies in patients with preexisting conditions that predispose them to adverse drug effects. To understand the implications of this delivery model for patients, we propose the following: (1) To measure the effects of physician dispensing on use of specialty drugs for prostate cancer; (2) To determine the impact of physician dispensing of specialty drugs for prostate cancer on financial outcomes and coping behaviors; and (3) To measure the relationship between physician dispensing of specialty drugs for prostate cancer and patient safety. Results from this study will have real-world implications for men with advanced prostate cancer, who are naturally interested in getting the highest quality cancer care while avoiding the financial consequences commonly associated with oral specialty drugs.

项目摘要每年将近35,000人屈服于晚期前列腺癌，使其成为癌症的第二大原因男人之间的死亡。针对特定分子的口服特种药物的开发导致了范式男性可以在家中接受前列腺癌的治疗的转变。口服特种药物，例如阿比罗酮和enzalutamide具有与毒性较小的物理施用化学疗法相似的效率这是截至2015年的晚期前列腺癌最常见的一线治疗。交付系统中的同时变化涉及范式。越来越多的处方对于口服特种药物，泌尿科医生或医学肿瘤科医生直接在其办公室中分发作为“医师分配”）。患者可以从这种交付模型中受益，因为它赋予了授权的责任并确定处方医师的财政援助。结合整合和通过在护理点处分配所隐含的协调，该交付模型可以改善访问，及时性和遵守这些特殊药物。但是，与身体分配相关的经济激励措施，通过每个处方填充产生的边距，可能会促进规定行为，以促进利用率破坏了该输送系统的价值变化，例如在患者中使用这些疗法使它们容易产生不良药物作用的条件。了解该交付模型的含义对于患者，我们提出以下建议：（1）测量物理分配对使用专业的影响前列腺癌的药物；（2）确定特种药物对前列腺的物理分配的影响财务结果和应对行为的癌症；（3）衡量物理学之间的关系分配专门用于前列腺癌和患者安全的药物。这项研究的结果将具有现实世界对患有晚期前列腺癌的男性的影响，他们自然有兴趣获得最高质量癌症护理同时避免了通常与口服特种药物相关的财务后果。