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：
10560826
负责人：
BRENT K. HOLLENBECK
金额：
$ 4.49万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
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 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10560826
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.

项目概要每年有近 35,000 人死于晚期前列腺癌，使其成为第二大癌症原因针对特定分子的口服特殊药物的开发已经形成了一个范例。男性可以在家接受前列腺癌的治疗，例如口服特殊药物。阿比特龙和恩杂鲁胺与医生进行的化疗具有相似的疗效，但毒性较小截至 2015 年，这是晚期前列腺癌最常见的一线治疗方法。这种新疗法范式伴随着给药系统的同时变化，处方也越来越多。对于口腔专用药物，由泌尿科医师或肿瘤内科医师在其办公室直接配药（称为患者可以从这种交付模式中受益，因为它承担了授权的责任。并结合整合和确定对处方医生的经济援助。通过在护理点配药所暗示的协调，这种交付模式可以改善可及性、及时性和然而，与医生配药相关的经济激励，通过每次处方配药产生的余量，可以促进处方行为，促进利用破坏了这种传递系统改变的价值，例如在已有疾病的患者中使用这些疗法使他们容易产生药物不良反应的条件，以了解这种给药模式的影响。对于患者，我们提出以下建议：（1）衡量医生配药对专业使用的影响治疗前列腺癌的药物；(2) 确定医生配药治疗前列腺的特殊药物的影响癌症对财务结果和应对行为的影响；以及 (3) 衡量医生之间的关系这项研究的结果将反映现实世界中前列腺癌特殊药物的分配和患者安全。对患有晚期前列腺癌的男性的影响，他们自然对获得最高质量的产品感兴趣癌症护理，同时避免通常与特殊口服药物相关的经济后果。