ABSTRACT
Background: COVID-19 has impacted several areas of oncology patient care, most notably the reduction of patient visits for treatments. Standard treatment of multiple myeloma (MM) involves a combination of intravenous (IV) and oral therapies. Objective(s): The purpose of this study is to assess the impact COVID-19 had on IV and oral medication prescribing patterns pre and during the COVID-19 pandemic among MM patients. Method(s): This is a retrospective review of adult MM patients insured by a large commercial and Medicare health plan in the United States who started a new IV or oral MM agent during the study period. To assess the impact of COVID-19 on IV and oral medication prescribing patterns, we compared a pre-COVID period (1 March-31 August 2019) to a COVID period (1 March-31 August 2020). We utilized medical and pharmacy claims to identify patients and calculated new therapy starts per newly diagnosed patient (defined as the number of patients starting a new IV or oral medication for MM divided by the total number of patients with a first indication date of MM within the study timeframe). We compared rates using a Chi-square test;p-values <=.05 were considered statistically significant. Result(s): 1754 patients were enrolled in the study;there were no significant differences in demographic characteristics pre and during COVID-19 between the two groups with respect to age (67.05 vs. 66.64;p=.45), gender (p=.80), insurance plan type (p=.17), geographical region (p=.26) and medication (p=.59). During COVID-19, the number of newly diagnosed MM patients decreased by 22% (9657-7560) and the total number of new therapy starts decreased by 11% (930-824). When looking at rates of new therapy starts per newly diagnosed patient, both IV (11%;p=.03) and oral (51%;p=.03) medication rates significantly increased. Additionally, there were significant increases in new therapy start rates by region in the Northeast for oral (157%;p=.08). Conclusion(s): While the total count of new therapy starts, a proxy for new diagnoses, decreased during COVID-19, the rate of new starts for both IV and oral therapies for patients diagnosed with MM significantly increased. These increased start rates may be explained by a remarkable 22% drop in the total number of newly diagnosed MM patients during COVID-19. As the pandemic continues, further study is warranted to understand how COVID-19 may impact IV vs. oral usage in MM.
ABSTRACT
Background: CVS Health recently developed a best-in-class mobile app and website that enables oncology patients to start and stay on therapy. While digital patient engagement is relatively new, identifying and estimating the frequency of its use and the impact of COVID-19 on adherence are critical for planning strategies to mitigate the effects of the pandemic on cancer patient outcomes. Objective(s): This study examined the impact of COVID-19 on adherence to oral oncolytic agents in a large health plan with a significant digital health platform. Method(s): This retrospective cohort study included adult patients with chronic myelogenous leukemia (CML), ovarian cancer or prostate cancer initiating oral oncolytics between 3/1/19 and 3/ 1/2021. Patients were divided into two groups: pre-COVID oral oncolytic initiators before 3/1/20 and COVID initiators after 3/1/ 20 and were followed for 1 year after therapy initiation. The primary outcome was optimal adherence to oral oncolytic agents as defined by a medication possession ratio (MPR)>=0.8. Percent of digital engagement, defined as the number of times a patient interacted with the CVS digital platform, was examined as a secondary endpoint and was considered as a binary and categorical endpoint (none, low (<28), moderate (28-105) and high (>105)). Descriptive statistics and logistic regression modeling were performed;p-values <.05 were significant. Result(s): In total, 15,494 patients were included in the study, with 8067 (52.07%) in the pre-COVID initiator group. Patient demographics were similar across study groups, with the exception of pre-COVID initiators who were less likely to be male (75.32 vs. 77.34%;p<.01) and receive copay assistance (38.37 vs. 41.70%;p<.01). No difference in digital engagement pre and during COVID was noted (74.55 vs. 73.60%;p=.18). Pre-COVID initiators were less likely to be optimally adherent than COVID initiators (84.75 vs. 85.96%;p=.04). Therapy persistence was more common among COVID initiators, with greater number of fills (Median [quartile (Q) Q1-Q3]: 10 [4-12] vs. 9[4-12];p<.01) and less changes to therapy (8.87 vs. 9.95%;p=.02). After regression, COVID initiation of oral oncolytics was not associated with optimal adherence (odds ratio (OR) = 1.06 [95% (confidence interval (CI) 0.96-1.16]). Adherence increased as digital engagement increased (low: OR 0.64 [95% CI 0.56-0.72];moderate: OR 0.67 [95% CI 0.56-0.76];high: OR 1.71 [95% CI 1.48-1.99]). Other factors associated with increased adherence were copay assistance, male gender and age between 65 and 84 (all p<.05). Factors associated with decreased adherence were therapy change, CML and age <50 years (all p<.05). Conclusion(s): The onset of the COVID-19 pandemic did not significantly impact optimal adherence for new-to-therapy oral oncology patients. Patients with high digital engagement during the pandemic experienced significantly improved adherence than those not engaged. Additionally, persistence and number of fills were slightly improved in COVID initiators, suggesting that the current pandemic may have influenced adherence behaviors.
ABSTRACT
Background: COVID-19 has impacted several areas of oncology patient care, most notably the reduction of patient visits for treatments. Standard treatment of multiple myeloma (MM) involves a combination of intravenous (IV) and oral therapies. The purpose of this study is to assess the impact COVID-19 had on IV and oral medication prescribing patterns pre and during the COVID-19 pandemic among MM patients. Methods: This is a retrospective review of adult MM patients insured by a large commercial and Medicare health plan in the United States who started a new IV or oral MM agent during the study period. To assess the impact of COVID-19 on IV and oral medication prescribing patterns, we compareda pre-COVID period (March 1-August 31, 2019) to a COVID period (March 1-August 31, 2020). We utilized medical and pharmacy claims to identify patients and calculated new therapy starts per newly diagnosed patient (defined as the number of patients starting a new IV or oral medication for MM divided by the total number of patients with a first indication date of MM within the study timeframe). We compared rates using a Chi-square test;p-values ≤ 0.05 were considered statistically significant. Results: 1,754 patients were enrolled in the study;there were no significant differences in demographic characteristics pre and during COVID-19 between the two groups with respect to age (67.05 vs. 66.64;p=0.45), gender (p=0.80), insurance plan type (p=0.17), geographical region (p=0.26) and medication (p=0.59). During COVID-19, the number of newly diagnosed MM patients decreased by 22% (9,657 to 7,560) and the total number of new therapy starts decreased by 11% (930 to 824). When looking at rates of new therapy starts per newly diagnosed patient, both IV (11%;p=0.03) and oral (51%;p=0.03) medication rates significantly increased. Additionally, there were significant increases in new therapy start rates by region in the Northeast for oral (157%;p<0.01) and West for IV (32%;p=0.02) medications. There were no significant differences in new start rates by insurance plan type (all p>0.08). Conclusions: While the total count of new therapy starts, a proxy for new diagnoses, decreased during COVID-19, the rate of new starts for both IV and oral therapies for patients diagnosed with MM significantly increased. These increased start rates may be explained by a remarkable 22% drop in the total number of newly diagnosed MM patients during COVID-19. As the pandemic continues, further study is warranted to understand how COVID-19 may impact IV vs. oral usage in MM.
ABSTRACT
Background: COVID-19 has substantially decreased cancer screening, management visits and surgeries. CVS Health recently developed a best-in-class mobile app and website that enables oncology patients to start and stay on therapy. This study examined the impact of COVID-19 on adherence to oral oncolytic agents in a large health plan with a significant digital health platform. Methods: This retrospective cohort study included adult patients with chronic myelogenous leukemia (CML), ovarian cancer or prostate cancer initiating oral oncolytics between 3/1/19 and 3/1/2021. Patients were divided into two groups: pre-COVID oral oncolytic initiators before 3/1/20 and COVID initiators after 3/1/20 and were followed for 1 year after therapy initiation. The primary outcome was optimal adherence to oral oncolytic agents as defined by a medication possession ratio (MPR) ≥ 0.8. Percent of digital engagement, defined as the number of times a patient interacted with the CVS digital platform, was examined as a secondary endpoint and was considered as a binary and categorical endpoint (none, low (< 28), moderate (28-105) and high (> 105)). Descriptive statistics and logistic regression modeling were performed;p-values < 0.05 were significant. Results: In total, 15,494 patients were included in the study, with 8,067 (52.07%) in the pre-COVID initiator group. Patient demographics were similar across study groups, with the exception of pre-COVID initiators who were less likely to be male (75.32% vs. 77.34%;p < 0.01) and receive copay assistance (38.37% vs. 41.70%;p < 0.01). No difference in digital engagement pre and during COVID was noted (74.55% vs. 73.60%;p = 0.18). Pre-COVID initiators were less likely to be optimally adherent than COVID initiators (84.75% vs. 85.96%;p = 0.04). Therapy persistence was more common among COVID initiators, with greater number of fills (Median [quartile (Q) Q1-Q3]: 10 [4-12] vs. 9[4-12];p < 0.01) and less changes to therapy (8.87% vs. 9.95%;p = 0.02). After regression, COVID initiation of oral oncolytics was not associated with optimal adherence (odds ratio (OR) = 1.06 [95% (confidence interval (CI) 0.96-1.16]). Adherence increased as digital engagement increased (low: OR 0.64 [95% CI 0.56-0.72];moderate: OR 0.67 [95% CI 0.56-0.76];high: OR 1.71 [95% CI 1.48-1.99]). Other factors associated with increased adherence were copay assistance, male gender and age between 65 and 84 (all p < 0.05). Factors associated with decreased adherence were therapy change, CML and age < 50 years (all p < 0.05). Conclusions: The onset of the COVID-19 pandemic did not significantly impact optimal adherence for new-to-therapy oral oncology patients. Patients with high digital engagement during the pandemic experienced significantly improved adherence than those not engaged. Additionally, persistence and number of fills were slightly improved in COVID initiators, suggesting that the current pandemic may have influenced adherence behaviors.