Cost-Related Medication Nonadherence Among Elderly Medicare Cancer Survivors Using Erythropoiesis-Stimulating Agents

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6

treated at a physician-owned practice (HR= 0.61). Relative to sunitinib, all other treatments reported significantly shorter persistence (HRs= 1.32 [pazopanib] to 2.43 [bevacizumab], all p< .05).  Conclusions: 1L treatment persistence varied significantly across RCC treatments and region. In part due to the reduced likelihood of side effects, persistence was greatest for sunitinib and pazopanib, though several practice-related factors (e.g., country, physician specialty, and office environment) contributed significantly. PCN196 The Effect of Depression on Adherence To Hormone Therapy in Breast Cancer Patients Noxon V University of South Carolina, Columbia, SC, USA

Objectives: Breast cancer patients with depression before or after their diagnosis have been shown to have increased cost, shorter survival time and reduced adherence to hormone therapy. Currently, no study has determined the association of concurrent depression while adjusting for a history of depression with adherence to hormone therapy. The objective of this study is to determine the association of concurrent depression with adherence to hormone therapy adjusting for a history of depression.  Methods: Breast cancer patients with hormone receptor positive cancers diagnosed from 2006 to 2009 were identified in the linked SEER-Medicare dataset. Patients must have started hormone therapy within a year of cancer diagnosis to be included and have at least 1 year and up to 4 years of follow up. Patients who had an ICD-9 code for depression within a year of cancer diagnosis were classified as currently depressed. Adherence was measured using percent days covered (PDC) and was calculated for each quarter during follow up. A generalized linear model with repeated measures was used to determine the association of concurrent depression with adherence to hormone therapy.  Results: 10,471 hormone receptor positive breast cancer patients who took hormone therapy were identified. Of these, 10% were currently depressed. Those with depression consistently had lower PDC values for each quarter during follow up. Current depression was associated with a 19% reduction (p< .01) in the odds of adhering to hormone therapy after adjusting for a prior history of depression in addition to other confounders. A prior history of depression was also associated with a 15% reduction (p< .01) in the odds of adhering to hormone therapy after adjustment.  Conclusions: Concurrent depression is associated with significantly reduced adherence to hormone therapy in breast cancer patients. PCN197 Cost-Related Medication Nonadherence Among Elderly Medicare Cancer Survivors Using Erythropoiesis-Stimulating Agents Li M, Lu K, Cai B, Norris L, Schulz RM University of South Carolina, Columbia, SC, USA

Objectives: Use of erythropoiesis-stimulating agents (ESAs) poses a significant economic burden to elderly Medicare cancer survivors. The burden of high drug expense, especially for the elderly, is one of the major reasons to not adhere to prescription regimens. The objectives of this study were to 1) provide national estimates on the prevalence of cost-related medication nonadherence (CRN), 2) to examine the association between ESA use and CRN, and 3) identify predictors of CRN among elderly Medicare cancer survivors using ESAs.  Methods: This study was a pooled cross-sectional study of the Medicare Current Beneficiary Survey from 2006 to 2011. ESA users were defined as having at least one prescription of darbepoetin or epoetin in Medicare Part B or D. Self-reported CRN was the main outcome and was measured based on responses to four survey questions: taking smaller doses of prescriptions, skipping doses to make prescriptions last longer, delaying obtaining prescriptions because of cost, and not obtaining prescriptions because cost too much. Weighted logistic regression was conducted to identify predicators of CRN.  Results: ESA users had higher prevalence of CRN (9.82% vs. 6.98%, P= 0.0307), compared to ESA non-users. ESA use was associated with CRN (OR: 1.46, 95% CI: 1.03-2.07). Among elderly Medicare cancer survivors using ESAs, predictors of CRN included high outof-pocket (OOP) costs of ESAs ($100 to $500 per year, OR: 4.37, 95% CI: 1.17-16.30; $500 to $1,000 per year, OR: 17.39, 95% CI: 5.10-59.31; and > $1,000 per year, OR: 14.30, 95% CI: 4.04-50.55), disability status (OR: 2.47, 95% CI: 1.14-5.36), and without low-income subsidy (OR: 5.13, 95% CI: 1.60-16.42).  Conclusions: Centers for Medicare and Medicaid Services and healthcare providers should adopt new strategies for better access to prescribed regimens for patients with risks of nonadherence due to high OOP medical and prescription drug costs. PCN198 A Trial-Based Euroqol Eq-5d Health Utility Analysis in Patients with Previously Treated Advanced Nsclc Huang M, Pellissier J, Liao J Merck & Co., Inc., North Wales, PA, USA

Objectives: This study evaluated health-related quality of life utility in advanced NSCLC patients who have experienced disease progression after platinum-containing cheomotherapy.  Methods: This study examined EQ-5D data collected from patients enrolled in the KEYNOTE-010 trial, a multi-center, worldwide, randomized Phase II/III trial of pembrolizumab and docetaxel in patients with previously treated advanced NSCLC with PD-L1 positive tumors.  Two approaches of defining health states are considered in analysing utility: time-todeath reflecting decline in cancer patient’s quality of life as they approach death, and progression-based health states. Generic health statuses assessed from the EQ-5D questionnaire were converted to population-based utility values using published algorithms. The utility scores from the pooled treatment groups are reported.  Results: Data came from 560 patients who had at least one evaluable

EQ-5D record. Mean utility score for patients in progression-free and progressive disease state is 0.76 (95% CI 0.75, 0.77) and 0.69 (95% CI 0.66, 0.71), respectively. Mean utility showed a decrease on disease progression of 0.07, which is considered as clinically meaningful. Patients were split into five groups based on their time to death after the EQ-5D questionnaire was taken - over 360 days, 180–360 days, 90–180 days, 30–90 days, and under 30 days, and mean utility in each timeto-death category is 0.81(95% CI 0.79, 0.83),0.73 (95% CI 0.71, 0.75),0.69(95% CI 0.66, 0.72),0.60 (95% CI 0.56, 0.64) and 0.40 (95% CI 0.31, 0.48).the results showed a large decrease in utility in the 30 days prior to death.  Conclusions: The results showed that quality of life for pre-treated advanced NSCLC patients rapidly deteriorates during the end of life period. Considerable deterioration of utility in NSCLC patients is associated with disease progression and time to death. The utility values estimated from the study will inform economic evaluations of treatments in pre-treated advanced NSCLC. PCN200 Health State Utilities for Persistent, Recurrent or Metastatic Cervical Cancer in France Chevalier J1, Lambert J2, Floquet A3, Alexandre J4, Ghazi Y5, Plommet N6 1Mapi, Paris, France, 2Mapi, Lyon, France, 3Institut Bergonié, Bordeaux, France, 4Cochin Hospital/Hotel Dieu, AP-HP, Paris Descartes University (University of Paris V), Paris, France, 5F. Hoffmann-La Roche, Boulogne-Billancourt, France, 6Roche SAS, Boulogne-Billancourt, France

Objectives: In the absence of published utility values for persistent, recurrent or metastatic cervical cancer in France, the present study aimed to obtain Frenchbased societal preferences for distinct stages of the disease and selected treatment-related adverse events (AEs).  Methods: Eight hypothetical health states and their descriptions were developed on the basis of literature review and interviews with two clinicians, three nurses and two patients with persistent, recurrent or metastatic cervical cancer. They described three primary disease states (progression free survival (PFS), progression with palliative treatment and progression with chemotherapy) and five AEs sub-states (PFS with vesico- or recto-vaginal fistulas, fatigue, infection, haemorrhage and peripheral neuropathy). A pilot study was conducted with adults from the French general population to ensure their understanding and appropriateness. In the main study, health states utilities were obtained by face to face interviews with 100 adults from the French general population using the time trade off (TTO). Visual analogue scale (VAS) scores were also obtained.  Results: The mean age of the respondents was 45.5 years and 54% were women. Utility values obtained for PFS (0.684), progression with chemotherapy (0.456) and progression with palliative treatment (0.092) followed the increase in severity of the disease. The disutility associated to the AEs ranged from 0.098 for fatigue to 0.459 for vesico- or recto-vaginal fistulas. On average, none of the states were valued as worse than death. The VAS results were in line with the TTO results.  Conclusions: This study underlines the value that French population places on the avoidance of disease progression and AEs in persistent, recurrent or metastatic cervical cancer. The particularly low utilities values suggesting poor health related quality of life bring out the seriousness and debilitating nature of these stages of the disease. These utility values might be used in future research to populate cost-utility analysis. PCN201 Measurement of Utilities by Time to Death Related to Advanced Non-Small Cell Lung Cancer in South Korea Chang C1, Park S1, CHOI YR1, Tan SC2, Kang SH3, Back HJ3, Suh D1 1Chung-Ang University, Seoul, South Korea, 2MSD, Singapore, Singapore, 3MSD, Seoul, South Korea

Objectives: To measure and analyse utility values for 5 different time-to-death periods associated with advanced non-small cell lung cancer (NSCLC) using time trade-off (TTO) method through a sample of general public respondents in South Korea.  Methods: Health state descriptions for 5 different time intervals to death (i.e., over 360 days, 180-360 days, 90-180 days, 30-90 days and under 30 days) were developed with inputs from an expert panel of experiecned clinical oncologists on the 5 possible levels of severity in each of the 8 domains ranging from clinical symptoms including pain, breathlessness, cough, and loss of appetite and functionality including social, physical, sexual, and emotional wellbeing. Health states were valued by the respondents aged 30-69 using TTO method. The descriptive summary statistics (i.e., mean and 95% confidence interval) for the utility values were calculated to examine the health state utility perceived by the participants. A mixed-effects model was used to account for correlation between repeated responses provided by the same participants. All analyses were performed using SAS 9.2 (SAS Institute Inc., Caary, NC, USA)  Results: The study was completed by 205 participants (mean age: 47.4±10.7; 50.2% male). The mean utilities for health states by time-to-death using the TTO were 0.904 (95%CI:0.892-0.917) for over 360 days, 0.720 (95%CI:0.692-0.748) for 180-360 days, 0.627 (95%CI:0.598-0.655) for 90-180 days, 0.379 (95%CI:0.349-0.409) for 30-90 days, and 0.195 (95%CI:0.172-0.218) for under 30 days. The estimated results by the mixed-effects model showed a pattern of decline as the disease progresses to death. The utility values appear lower for participants who were older, male, single, divorced, separated or widowed.  Conclusions: This study is the first study in which utility values based on time-to-death associated with advanced NSCLC using TTO method were elicited by public respondents. The utility values could serve as a valuable resource for future economics research. PCN202 Comparison of German, French and Polish Utility Weights for The Eortc Utility Instrument QLU-C10D