The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early-stage breast cancer

Dawn L. Hershman, Jennifer Tsui, Jay Meyer, Sharon Glied, Grace Clarke Hillyer, Jason D. Wright, Alfred I. Neugut

Research output: Contribution to journalArticle

Abstract

Background: Nonadherence to hormonal therapy is common and is associated with increased copayment amount. We investigated the change in adherence after the introduction of generic aromatase inhibitors (AIs) in 2010. Methods: Using deidentified pharmacy and claims data from OptumInsight, we identified women older than 50 years on brand-name AIs (BAIs) and/or generic AIs (GAIs) for early breast cancer between January 1, 2007 and December 31, 2012. Clinical, demographic, and financial variables were evaluated. Adherence was defined as a medication possession ratio (MPR) 80% or greater. Results: We identified 5511 women, 2815 (51.1%) on BAI, 1411 (25.6%) on GAI, and 1285 (23.3%) who switched from BAI to GAI. The median 30-day copayment was higher for BAI ($33.3) than for GAI ($9.04). In a multivariable Coxproportional hazard analysis, women who took GAI were less likely to discontinue therapy (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.57 to 0.84) compared with BAI. Discontinuation was positively associated with a higher monthly copayment of $15 to $30 (HR = 1.21, 95% CI = 1.01 to 1.44) and more than $30 (HR = 1.49, 95% CI = 1.23 to 1.80) compared with less than $15. In a multivariable logistic regression analysis, adherence (medication possession ratio = 80%) was positively associated with GAI use (odds ratio = 1.53, 95% CI = 1.22 to 1.91) compared with BAI and inversely associated with increased monthly copayment. In addition, adherence was associated with a high annual income of more than $100k/year (odds ratio = 1.58, 95% CI = 1.17 to 2.11). Conclusions: Higher prescription copayment amount was associated with nonadherence and discontinuation of AIs. After controlling for copayment, discontinuation was higher and adherence was lower with Brand AIs. Because nonadherence is associated with worse survival, efforts should be directed towards reducing out-of-pocket costs for these life-saving medications.

Original languageEnglish (US)
Article numberdju319
JournalJournal of the National Cancer Institute
Volume106
Issue number11
DOIs
StatePublished - Nov 1 2014

Fingerprint

Aromatase Inhibitors
Names
Hormones
Breast Neoplasms
Confidence Intervals
Therapeutics
Odds Ratio
Medication Adherence
Health Expenditures
Prescriptions
Logistic Models
Regression Analysis
Demography
Survival

ASJC Scopus subject areas

  • Medicine(all)
  • Oncology
  • Cancer Research

Cite this

The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early-stage breast cancer. / Hershman, Dawn L.; Tsui, Jennifer; Meyer, Jay; Glied, Sharon; Hillyer, Grace Clarke; Wright, Jason D.; Neugut, Alfred I.

In: Journal of the National Cancer Institute, Vol. 106, No. 11, dju319, 01.11.2014.

Research output: Contribution to journalArticle

Hershman, Dawn L. ; Tsui, Jennifer ; Meyer, Jay ; Glied, Sharon ; Hillyer, Grace Clarke ; Wright, Jason D. ; Neugut, Alfred I. / The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early-stage breast cancer. In: Journal of the National Cancer Institute. 2014 ; Vol. 106, No. 11.
@article{064c00ebaa694ce493370f43cfc5e91a,
title = "The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early-stage breast cancer",
abstract = "Background: Nonadherence to hormonal therapy is common and is associated with increased copayment amount. We investigated the change in adherence after the introduction of generic aromatase inhibitors (AIs) in 2010. Methods: Using deidentified pharmacy and claims data from OptumInsight, we identified women older than 50 years on brand-name AIs (BAIs) and/or generic AIs (GAIs) for early breast cancer between January 1, 2007 and December 31, 2012. Clinical, demographic, and financial variables were evaluated. Adherence was defined as a medication possession ratio (MPR) 80{\%} or greater. Results: We identified 5511 women, 2815 (51.1{\%}) on BAI, 1411 (25.6{\%}) on GAI, and 1285 (23.3{\%}) who switched from BAI to GAI. The median 30-day copayment was higher for BAI ($33.3) than for GAI ($9.04). In a multivariable Coxproportional hazard analysis, women who took GAI were less likely to discontinue therapy (hazard ratio [HR] = 0.69, 95{\%} confidence interval [CI] = 0.57 to 0.84) compared with BAI. Discontinuation was positively associated with a higher monthly copayment of $15 to $30 (HR = 1.21, 95{\%} CI = 1.01 to 1.44) and more than $30 (HR = 1.49, 95{\%} CI = 1.23 to 1.80) compared with less than $15. In a multivariable logistic regression analysis, adherence (medication possession ratio = 80{\%}) was positively associated with GAI use (odds ratio = 1.53, 95{\%} CI = 1.22 to 1.91) compared with BAI and inversely associated with increased monthly copayment. In addition, adherence was associated with a high annual income of more than $100k/year (odds ratio = 1.58, 95{\%} CI = 1.17 to 2.11). Conclusions: Higher prescription copayment amount was associated with nonadherence and discontinuation of AIs. After controlling for copayment, discontinuation was higher and adherence was lower with Brand AIs. Because nonadherence is associated with worse survival, efforts should be directed towards reducing out-of-pocket costs for these life-saving medications.",
author = "Hershman, {Dawn L.} and Jennifer Tsui and Jay Meyer and Sharon Glied and Hillyer, {Grace Clarke} and Wright, {Jason D.} and Neugut, {Alfred I.}",
year = "2014",
month = "11",
day = "1",
doi = "10.1093/jnci/dju319",
language = "English (US)",
volume = "106",
journal = "Journal of the National Cancer Institute",
issn = "0027-8874",
publisher = "Oxford University Press",
number = "11",

}

TY - JOUR

T1 - The change from brand-name to generic aromatase inhibitors and hormone therapy adherence for early-stage breast cancer

AU - Hershman, Dawn L.

AU - Tsui, Jennifer

AU - Meyer, Jay

AU - Glied, Sharon

AU - Hillyer, Grace Clarke

AU - Wright, Jason D.

AU - Neugut, Alfred I.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Background: Nonadherence to hormonal therapy is common and is associated with increased copayment amount. We investigated the change in adherence after the introduction of generic aromatase inhibitors (AIs) in 2010. Methods: Using deidentified pharmacy and claims data from OptumInsight, we identified women older than 50 years on brand-name AIs (BAIs) and/or generic AIs (GAIs) for early breast cancer between January 1, 2007 and December 31, 2012. Clinical, demographic, and financial variables were evaluated. Adherence was defined as a medication possession ratio (MPR) 80% or greater. Results: We identified 5511 women, 2815 (51.1%) on BAI, 1411 (25.6%) on GAI, and 1285 (23.3%) who switched from BAI to GAI. The median 30-day copayment was higher for BAI ($33.3) than for GAI ($9.04). In a multivariable Coxproportional hazard analysis, women who took GAI were less likely to discontinue therapy (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.57 to 0.84) compared with BAI. Discontinuation was positively associated with a higher monthly copayment of $15 to $30 (HR = 1.21, 95% CI = 1.01 to 1.44) and more than $30 (HR = 1.49, 95% CI = 1.23 to 1.80) compared with less than $15. In a multivariable logistic regression analysis, adherence (medication possession ratio = 80%) was positively associated with GAI use (odds ratio = 1.53, 95% CI = 1.22 to 1.91) compared with BAI and inversely associated with increased monthly copayment. In addition, adherence was associated with a high annual income of more than $100k/year (odds ratio = 1.58, 95% CI = 1.17 to 2.11). Conclusions: Higher prescription copayment amount was associated with nonadherence and discontinuation of AIs. After controlling for copayment, discontinuation was higher and adherence was lower with Brand AIs. Because nonadherence is associated with worse survival, efforts should be directed towards reducing out-of-pocket costs for these life-saving medications.

AB - Background: Nonadherence to hormonal therapy is common and is associated with increased copayment amount. We investigated the change in adherence after the introduction of generic aromatase inhibitors (AIs) in 2010. Methods: Using deidentified pharmacy and claims data from OptumInsight, we identified women older than 50 years on brand-name AIs (BAIs) and/or generic AIs (GAIs) for early breast cancer between January 1, 2007 and December 31, 2012. Clinical, demographic, and financial variables were evaluated. Adherence was defined as a medication possession ratio (MPR) 80% or greater. Results: We identified 5511 women, 2815 (51.1%) on BAI, 1411 (25.6%) on GAI, and 1285 (23.3%) who switched from BAI to GAI. The median 30-day copayment was higher for BAI ($33.3) than for GAI ($9.04). In a multivariable Coxproportional hazard analysis, women who took GAI were less likely to discontinue therapy (hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.57 to 0.84) compared with BAI. Discontinuation was positively associated with a higher monthly copayment of $15 to $30 (HR = 1.21, 95% CI = 1.01 to 1.44) and more than $30 (HR = 1.49, 95% CI = 1.23 to 1.80) compared with less than $15. In a multivariable logistic regression analysis, adherence (medication possession ratio = 80%) was positively associated with GAI use (odds ratio = 1.53, 95% CI = 1.22 to 1.91) compared with BAI and inversely associated with increased monthly copayment. In addition, adherence was associated with a high annual income of more than $100k/year (odds ratio = 1.58, 95% CI = 1.17 to 2.11). Conclusions: Higher prescription copayment amount was associated with nonadherence and discontinuation of AIs. After controlling for copayment, discontinuation was higher and adherence was lower with Brand AIs. Because nonadherence is associated with worse survival, efforts should be directed towards reducing out-of-pocket costs for these life-saving medications.

UR - http://www.scopus.com/inward/record.url?scp=84929405050&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929405050&partnerID=8YFLogxK

U2 - 10.1093/jnci/dju319

DO - 10.1093/jnci/dju319

M3 - Article

C2 - 25349080

AN - SCOPUS:84929405050

VL - 106

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

SN - 0027-8874

IS - 11

M1 - dju319

ER -