The 340B Drug Pricing Program and Management of Advanced Prostate Cancer
ABSTRACT Introduction Oral targeted therapies are a standard of care for men with advanced prostate cancer. However, these therapies are expensive, which may be a barrier to some, particularly the most economically disadvantaged. Through investment in programs to assist this population, savings gene...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-01-01
|
| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.70552 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841543402446913536 |
|---|---|
| author | Kassem S. Faraj Samuel R. Kaufman Mary Oerline Christopher Dall Arnav Srivastava Megan E. V. Caram Vahakn B. Shahinian Brent K. Hollenbeck |
| author_facet | Kassem S. Faraj Samuel R. Kaufman Mary Oerline Christopher Dall Arnav Srivastava Megan E. V. Caram Vahakn B. Shahinian Brent K. Hollenbeck |
| author_sort | Kassem S. Faraj |
| collection | DOAJ |
| description | ABSTRACT Introduction Oral targeted therapies are a standard of care for men with advanced prostate cancer. However, these therapies are expensive, which may be a barrier to some, particularly the most economically disadvantaged. Through investment in programs to assist this population, savings generated from the 340B program have the potential to mitigate barriers to initiating treatment with targeted therapies in these men. Methods We performed a retrospective study using a 20% national sample of fee‐for‐service Medicare beneficiaries diagnosed with advanced prostate cancer between 2012 and 2019. The outcome was the patient‐level use of a targeted therapy for the first time. This study had two exposures. The first was 340B penetration, representing the percentage of all outpatient hospital revenue in a hospital referral region generated by a 340B hospital. The second was the degree of socioeconomic disadvantage, as measured by the social vulnerability index (SVI). Two separate Cox models were fit to measure relationships between each exposure and use of a targeted therapy. A third model was fitted to assess whether differences in utilization by SVI were mitigated by increasing 340B penetration. Results The use of a targeted therapy did not vary with 340B penetration (adjusted HR 1.1, 95% CI 0.96–1.2) for high versus low penetration. Conversely, socioeconomically disadvantaged men were less likely to initiate treatment. Those residing in the third SVI tertile (i.e., most vulnerable) were less likely to start on a targeted therapy compared to men in the first tertile (adjusted HR 0.85, 95% CI 0.78–0.92). However, increasing 340B penetration did not attenuate these differences (Wald test for the interaction term p = 0.10). Conclusions There was no association between a region's 340B penetration and use of a targeted therapy. Furthermore, although the use of a targeted therapy decreased with increased SVI, the 340B penetration of a region did not reduce this gap. |
| format | Article |
| id | doaj-art-5266c55482424520b661de00d681272e |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-5266c55482424520b661de00d681272e2025-01-13T13:22:38ZengWileyCancer Medicine2045-76342025-01-01141n/an/a10.1002/cam4.70552The 340B Drug Pricing Program and Management of Advanced Prostate CancerKassem S. Faraj0Samuel R. Kaufman1Mary Oerline2Christopher Dall3Arnav Srivastava4Megan E. V. Caram5Vahakn B. Shahinian6Brent K. Hollenbeck7Dow Division of Health Services Research, Department of Urology University of Michigan Ann Arbor Michigan USADow Division of Health Services Research, Department of Urology University of Michigan Ann Arbor Michigan USADow Division of Health Services Research, Department of Urology University of Michigan Ann Arbor Michigan USADepartment of Urology Massachusetts General Hospital Boston Massachusetts USADow Division of Health Services Research, Department of Urology University of Michigan Ann Arbor Michigan USAVA Health Services Research and Development, Center for Clinical Management Research VA Ann Arbor Healthcare System Ann Arbor Michigan USADivision of Nephrology, Department of Internal Medicine University of Michigan Ann Arbor Michigan USADepartment of Urology Massachusetts General Hospital Boston Massachusetts USAABSTRACT Introduction Oral targeted therapies are a standard of care for men with advanced prostate cancer. However, these therapies are expensive, which may be a barrier to some, particularly the most economically disadvantaged. Through investment in programs to assist this population, savings generated from the 340B program have the potential to mitigate barriers to initiating treatment with targeted therapies in these men. Methods We performed a retrospective study using a 20% national sample of fee‐for‐service Medicare beneficiaries diagnosed with advanced prostate cancer between 2012 and 2019. The outcome was the patient‐level use of a targeted therapy for the first time. This study had two exposures. The first was 340B penetration, representing the percentage of all outpatient hospital revenue in a hospital referral region generated by a 340B hospital. The second was the degree of socioeconomic disadvantage, as measured by the social vulnerability index (SVI). Two separate Cox models were fit to measure relationships between each exposure and use of a targeted therapy. A third model was fitted to assess whether differences in utilization by SVI were mitigated by increasing 340B penetration. Results The use of a targeted therapy did not vary with 340B penetration (adjusted HR 1.1, 95% CI 0.96–1.2) for high versus low penetration. Conversely, socioeconomically disadvantaged men were less likely to initiate treatment. Those residing in the third SVI tertile (i.e., most vulnerable) were less likely to start on a targeted therapy compared to men in the first tertile (adjusted HR 0.85, 95% CI 0.78–0.92). However, increasing 340B penetration did not attenuate these differences (Wald test for the interaction term p = 0.10). Conclusions There was no association between a region's 340B penetration and use of a targeted therapy. Furthermore, although the use of a targeted therapy decreased with increased SVI, the 340B penetration of a region did not reduce this gap.https://doi.org/10.1002/cam4.70552androgen receptor antagonistshealth policyhealthcare disparitiesprostatic neoplasmssocial vulnerability |
| spellingShingle | Kassem S. Faraj Samuel R. Kaufman Mary Oerline Christopher Dall Arnav Srivastava Megan E. V. Caram Vahakn B. Shahinian Brent K. Hollenbeck The 340B Drug Pricing Program and Management of Advanced Prostate Cancer Cancer Medicine androgen receptor antagonists health policy healthcare disparities prostatic neoplasms social vulnerability |
| title | The 340B Drug Pricing Program and Management of Advanced Prostate Cancer |
| title_full | The 340B Drug Pricing Program and Management of Advanced Prostate Cancer |
| title_fullStr | The 340B Drug Pricing Program and Management of Advanced Prostate Cancer |
| title_full_unstemmed | The 340B Drug Pricing Program and Management of Advanced Prostate Cancer |
| title_short | The 340B Drug Pricing Program and Management of Advanced Prostate Cancer |
| title_sort | 340b drug pricing program and management of advanced prostate cancer |
| topic | androgen receptor antagonists health policy healthcare disparities prostatic neoplasms social vulnerability |
| url | https://doi.org/10.1002/cam4.70552 |
| work_keys_str_mv | AT kassemsfaraj the340bdrugpricingprogramandmanagementofadvancedprostatecancer AT samuelrkaufman the340bdrugpricingprogramandmanagementofadvancedprostatecancer AT maryoerline the340bdrugpricingprogramandmanagementofadvancedprostatecancer AT christopherdall the340bdrugpricingprogramandmanagementofadvancedprostatecancer AT arnavsrivastava the340bdrugpricingprogramandmanagementofadvancedprostatecancer AT meganevcaram the340bdrugpricingprogramandmanagementofadvancedprostatecancer AT vahaknbshahinian the340bdrugpricingprogramandmanagementofadvancedprostatecancer AT brentkhollenbeck the340bdrugpricingprogramandmanagementofadvancedprostatecancer AT kassemsfaraj 340bdrugpricingprogramandmanagementofadvancedprostatecancer AT samuelrkaufman 340bdrugpricingprogramandmanagementofadvancedprostatecancer AT maryoerline 340bdrugpricingprogramandmanagementofadvancedprostatecancer AT christopherdall 340bdrugpricingprogramandmanagementofadvancedprostatecancer AT arnavsrivastava 340bdrugpricingprogramandmanagementofadvancedprostatecancer AT meganevcaram 340bdrugpricingprogramandmanagementofadvancedprostatecancer AT vahaknbshahinian 340bdrugpricingprogramandmanagementofadvancedprostatecancer AT brentkhollenbeck 340bdrugpricingprogramandmanagementofadvancedprostatecancer |