For antiemetic prophylaxis, a model of shared cost-savings using incentives such as cash rebates might reduce the high cost of some pharmaceuticals while maintaining patient access to optimal care, according to oncologists from Michigan.
The investigators wanted to determine whether patients receiving chemotherapy could be enticed to choose a less expensive antiemetic regimen if given a choice. “We considered using a ‘carrot’ instead of a ‘stick’—a cash rebate earned by choosing less costly care,” said Emily Z. Touloukian, DO, an oncologist at Providence Hospital, Southfield, Michigan.
Although costly copays serve as disincentives for patients to ask for more costly regimens, the potential cost-saving impact of this is often thwarted by manufacturers’ patient assistance programs, Touloukian noted. She and her colleagues chose antiemetic regimens for the model, because choice does not affect patient survival, but her findings could have implications for other types of treatment choices.
Of the 162 study participants, 80% were women, 75% had cancer, and 50% had received previous chemotherapy. All participants completed a survey that portrayed 2 antiemetic programs.
Program A would have a 60% chance of completely eliminating nausea/vomiting at a cost of $200 per cycle. Program B would have 80% efficacy at a cost of $800 per cycle. If program A was ineffective, the patient could switch to program B at any time.
Both programs were described as covered by insurance; however, patients who selected program A would participate in the savings by receiving 50% of the cost difference, a $300 rebate per cycle.
More patients (58%) chose program A than program B (42%). Neither a previous history of cancer nor previous receipt of chemotherapy significantly affected program selection. Within the cohort who had previously received chemotherapy, 63% of pa tients who had experienced mild or no nausea in the past chose program A compared with 38% with moderate-to-severe nausea, “but we were greatly surprised that as many as 38% of patients who had trouble with prior nausea still chose the less effective program,” she said.
If all patients received 6 cycles of program B, the cost would be $777,600. By giving the patients a choice and reassigning the theoretical 40% of patients whose nausea was ineffectively controlled by program A to program B after 1 cycle, the cost dropped to $556,820.
This represented a savings of $220,780, or 28% of the total cost of the program, without limiting access to effective antiemetic care. One half of the savings went to the patients and half was saved by the payers, Touloukian said.