The impact of generic aromatase inhibitors on initiation, adherence, and persistence among women with breast cancer: Applying multi-state models to understand the dynamics of adherence. Pharmacoepidemiol Drug Saf 2020 May;29(5):550-557
Date
03/21/2020Pubmed ID
32196839Pubmed Central ID
PMC11363905DOI
10.1002/pds.4995Scopus ID
2-s2.0-85082067972 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
PURPOSE: Clinical trials have clearly documented the survival benefit of aromatase inhibitors (AIs); however, many women fail to initiate (primary nonadherence) or remain adherent to AIs (secondary nonadherence). Prior studies have found that costs impact secondary nonadherence to medications but have failed to examine primary nonadherence. The purpose of this study is to examine primary and secondary adherence following the reduction in copays due to the introduction of generic AIs.
METHODS: Using Surveillance, Epidemiology, and End Results-Medicare data, we identified 50 054 women diagnosed with incident breast cancer between 2008 and 2013. We compare women whose copays would change and those whose would not, due to the receipt of cost-sharing subsidies before and after generics were introduced using a difference-in-difference (DinD) analysis. To examine primary and secondary nonadherence, we rely on a multistate model with four states (Not yet initiated, User, Not Using, and Death). We adjusted for baseline factors using inverse probability treatment weights and then simulated adherence for 36 months following diagnosis.
RESULTS: The generic introduction of AIs resulted in patients initiating AIs faster (DinD = -4.7%, 95%CI = -7.0, -2.3; patients not yet initiating treatment at 6-months), being more adherent (DinD ranging in absolute increase of 8.1%-10.4%) and being less likely to not be using the therapy (DinD range in absolute decrease of 1.2% at 6 months to 8.8% at 24 months) for women that do not receive a subsidy after generics were available.
CONCLUSIONS: Introduction of generic alternatives to AIs significantly reduced primary and secondary nonadherence.
Author List
Winn AN, Fergestrom NM, Pezzin LE, Laud PW, Neuner JMAuthors
Purushottam W. Laud PhD Adjunct Professor in the Data Science Institute department at Medical College of WisconsinJoan Neuner MD, MPH Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Aromatase Inhibitors
Breast Neoplasms
Cohort Studies
Drugs, Generic
Female
Humans
Medicare
Medication Adherence
Models, Theoretical
SEER Program
Survival Analysis
United States
