Costs of ovarian cancer care since the introduction of poly (ADP-ribose) polymerase inhibitors (PARPis).

Abstract

e17568 Background: The objective of this study was to evaluate changes in medical and pharmacy costs among ovarian cancer (OC) patients since poly (ADP-ribose) polymerase inhibitors (PARPis) were first approved for OC in December 2014. Methods: Optum’s de-identified Clinformatics Data Mart Database was used to identify patients with incident OC between 2013 and 2021 who received platinum-based chemotherapy. Medical, outpatient, inpatient, computed tomography scan (CT), and pharmacy costs were analyzed by time since diagnosis when the costs were incurred, with four stratifications: the first 0-5, 6-11, 12-23, and 24-35 months past diagnosis. Median monthly standard costs were estimated, and inflation-adjusted out-of-pocket (OOP) costs were calculated. Median (interquartile range, IQR) costs per outpatient visit, CT, and month supply of PARPi were assessed. Results: There were 6,680 patients diagnosed with OC, with 5,888, 4,733, 2,801, and 1,696 enrolled for 0-5, 6-11, 12-23, and 24-35 months past diagnosis. From quarter 1, 2015 to quarter 3, 2020, median monthly medical, outpatient, and CT costs increased in all time periods, and pharmacy costs increased 6-35 months past diagnosis. For patients 0-5 months past diagnosis, median monthly inpatient standard costs increased from $6,032 to $6,615 and inpatient OOP costs decreased from $149 to $69. Median monthly inpatient standard and OOP costs 6-35 months past diagnosis were $0. Median (IQR) cost per outpatient visit increased from $40 (8-143) to $42 (8-165), per CT increased from $172 (136-557) to $175 (143-600), and per month supply of PARPi increased from $9,744 (9,744-9,744) to $14,449 (14,449-14,518). Median OOP cost per outpatient visit and CT was $0 and per month supply of PARPi decreased from $71 to $0. Conclusions: In the years of expanding PARPi use in OC, OC patients 6 or more months past diagnosis had increasing pharmacy costs. However, OC patients also incurred increasing medical, particularly outpatient and CT, costs despite minimal increases in the cost per visit or per CT, perhaps reflecting an increase in frequency of visits or CTs per patient or increased utilization of costlier diagnostics. OOP costs did not demonstrate the same increases as standard costs, but do not capture other costs to patients such as increasing premiums or time toxicity. Median monthly standard and out-of-pocket (OOP) medical, outpatient, CT, and pharmacy costs among ovarian cancer patients, quarter 1, 2015 and quarter 3, 2020, by months past diagnosis. Cost ($) Months past diagnosis Medical Medical Outpatient Outpatient CT CT Pharmacy Pharmacy 2015 2020 2015 2020 2015 2020 2015 2020 Standard 0-5 15,316 17,764 8,408 9,968 275 376 128 103 6-11 3,299 3,743 2,620 2,890 251 299 34 110 12-23 2,215 2,514 1,541 1,748 156 199 37 93 24-35 1,119 1,968 819 1,468 79 161 30 79 OOP 0-5 621 625 303 392 0 9 35 32 6-11 114 86 98 76 0 0 15 21 12-23 157 102 135 86 3 4 22 25 24-35 126 87 107 75 0 1 22 21