AJPB

Practice Economics and the Decision to Prescribe Oral Oncolytics | Page 2

Published Online: December 05, 2013
Karen E. Van Nuys, PhD; Joseph J. Conoshenti Jr, BPharm, RPh, MBA; and Dana P. Goldman, PhD
We also looked at other elements of practice economics including the profitability of IV infusion services or drugs relative to other services such as treatment planning, and how important convenience was likely to be for a practice’s patients based on average age or distance traveled for treatment. However, these factors, did not show strong correlations with practices’ willingness to substitute oral for IV oncolytics.

CONCLUSION

Our informal survey was designed to explore practice economics’ role in prescribing behavior rather than to test these theories rigorously. While our small convenience sample and inability to completely control for selective responses limit the generalizability of our results, our data suggest that practice economics may indeed infl uence doctors’ decisions to substitute oral for IV therapies. One implication is that patients trying to make informed decisions about their treatment might find greater transparency into these factors useful, and a larger, more generalizable study to test these hypotheses more rigorously would be illuminating.

There are, of course, many other factors influencing a doctor’s decision to prescribe an oral or IV agent, which may either augment or counterbalance their fi nancial incentives. For example, patient out-of-pocket expenses may be higher for oral medications, and compliance with oral chemotherapy is more difficult for the physician to monitor than with IV therapy. On the other hand, oral therapies would likely not require the physician to assume the same level of inventory risk that IV medications would. Yet an  understanding of the role of oncology practices’ economic situations in explaining or describing oncologists’ prescribing behavior will be increasingly important to effectively introduce more oral chemotherapy agents in the future.

Take-Away Points

Oncologists face conflicting incentives when choosing between oral and intravenous (IV) oncology drugs with equivalent efficacy/safety profi les, since oral prescriptions do not generate reimbursement for infusion services or IV drug margins. Our data suggest doctors may respond to these incentives, substituting oral for IV medications when they can capture greater profit from the oral formulation. Our work contributes to the ongoing process of hypothesis generation in the following areas:
  • How physicians are balancing financial incentives with other considerations 

  • Why some oral oncology agents are not widely adopted

  • What types of practices are most likely to adopt oral agents
Author Affiliations: From Precision Health Economics LLC (KEVN), Los Angeles, CA; Sanofi US (JJC), Bridgewater, NJ; Leonard D. Schaeffer Center for Health Policy and Economics, The University of Southern California (DPG), Los Angeles, CA. Mr Conoshenti Jr is now with Novartis.

Funding Source: This work was funded by Sanofi US, Bridgewater, NJ.

Author Disclosures: Dr Van Nuys reports that employment with Precision Health Economics LLC and that she received payment from Sanofi US for this research. Mr Conoshenti reports employment with Sanofi US. Dr Goldman reports that she has received consulting fees from Amgen, Amylin Pharmaceuticals, Bristol-Myers Squibb, Novartis, and Sanofi .

Authorship Information: Concept and design (KEVN, JJC, DPG); acquisition of data (KEVN); analysis and interpretation of data (KEVN, JJC); drafting of the manuscript (KEVN, JJC); critical revision of the manuscript for important intellectual content (KEVN, DPG); statistical analysis (KEVN); obtaining funding (JJC); and supervision (JJC, DPG).

Address correspondence to: Karen E. Van Nuys, PhD, Senior Research Economist, Precision Health Economics, 11100 Santa Monica Blvd, Santa Monica, CA 90025. E-mail: karen@precisionhealtheconomicscom.
1. The Global Use of Medicines: Outlook Through 2015, 2011, IMS Institutes for Healthcare Informatics. Parsippany, NJ.

2. Barefoot J, Blecher CS, Emery R. Keeping pace with oral chemotherapy. Oncol Iss. 2009:36-39.

3. Birner A. Safe administration of oral chemotherapy. Clin J Oncol Nurs. 2003; 72:158-162.

4. Oral oncology drugs achieve rapid growth, but perhaps not yet as much as expected. Spec Pharm News. 2008;5(10):1-5.

5. Jacobson M, Earl CC, Newhouse JP. Geographic variation in physicians’ responses to a reimbursement change. N Engl J Med. 2011;354(22):2049- 2052.
Issue: Specialty Pharmacy
More on AJMC.COM