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Adjuvant Endocrine Tx Adherence Disparity Due to Varying Costs

Racial/ethnic disparities in adherence explained by socioeconomic status, medication costs

FRIDAY, Nov. 4, 2016 (HealthDay News) — For women with hormone receptor-positive breast cancer, adherence to adjuvant endocrine therapy (AET) is mainly due to demographic variables and out-of-pocket medication costs, according to a study published online Oct. 28 in the Journal of Clinical Oncology.

Albert J. Farias, Ph.D., and Xianglin L. Du, M.D., Ph.D., from the University of Texas Health Science Center at Houston, conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare linked database to identify patients aged ≥65 years with hormone receptor-positive breast cancer who were enrolled in Medicare Part D from 2007 to 2009. Using the medication possession ratio (≥80 percent) during the 12-month period, the authors assessed adherence to tamoxifen, aromatase inhibitors (AIs), and overall AET.

The researchers found that 36.8 percent of the 8,688 patients were nonadherent to AET. The adjusted odds of adherence were lower with out-of-pocket costs for AET medication for all four cost categories compared with the lowest category of ≤$2.65. At initiation, Hispanics had higher odds of adherence to any AET and blacks had higher odds of adherence to AIs, both compared with non-Hispanic whites (odds ratios, 1.30 and 1.27, respectively). The correlations were no longer significant after adjustment for copayments, poverty status, and comorbidities. After adjustment for socioeconomic, clinical, and prognostic factors, blacks had significantly lower adjusted odds of adherence than non-Hispanic whites when they initiated AET therapy with tamoxifen (odds ratio, 0.54).

“Racial/ethnic disparities in AET adherence were largely explained by women’s differences in socioeconomic status and out-of-pocket medication costs,” the authors write.

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