Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
Arjun Gupta, Leonce Nshuti, Udhayvir Singh Grewal, Ramy Sedhom, Helen Parsons, Anne Hudson Blaes, Beth A. Virnig, Maryam B. Lustberg, Ishwaria Mohan Subbiah, Ryan David Nipp, Sydney M. Dy, Stacie Dusetzina
Background: To date, drugs used for CACS have limited efficacy and may have unwanted side effects. Despite this, clinicians commonly prescribe certain drugs for CACS, adding financial burden to patients through out-of-pocket costs near or at the end of life. We sought to describe the range of costs of the multiple drugs commonly used to manage CACS. Methods: We reviewed oncology, nutrition, and supportive care guidelines (ASCO, ESMO, ESPEN, MASCC) and compiled a list of drugs recommended for CACS. We also included drugs commonly used off-label in clinical practice as identified by study authors. Using GoodRx.com, we extracted available formulations (e.g., tablet [tab] vs capsule [cap] vs oral disintegrating tablet [ODT] vs solution [sol]), and brand name vs generic products for each drug. We identified the average retail price, and the lowest price with coupons, for each formulation using the most commonly used dosage for a 2-week period (typical fill). The average retail price is the cash price for consumers without prescription drug coverage. The lowest price represents a discounted, ??best case?? scenario of out-of-pocket costs for patients without prescription drug coverage. We collected data using the zip code 10065 in May 2021 to describe the range of costs of these drug formulations. Results: We included 7 drugs available in 20 formulations (Table). For a 2-week fill, the least expensive options included generic olanzapine 5 mg tab (once daily) and generic mirtazapine 15 mg tab (once daily), costing $4.50 per fill. Brand-name solutions were costly, ranging from $605.50 (megestrol acetate, Megace ES) to $1,156.30 (dronabinol, Syndros). Costs between formulations of the same drug/dosage varied widely: for olanzapine 5 mg, the lowest price varied from $4.50 [generic, tab] to $238.40 [Zyprexa zydis, brand-name, ODT]. Conclusions: We found that the costs of drugs used for CACS are highly variable, ranging from < $5 to > $1000 per fill. Overall there is limited data supporting use of drugs for managing CACS. Thus, our findings can help guide patient-clinician discussions about the risk/benefit ratio of a prescription for managing CACS, while highlighting the importance of seeking less expensive formulations when possible.
Drug | Brand name if brand | Formulation | Common dosage | Average retail price per fill ($) | Lowest price with coupon per fill ($) |
---|---|---|---|---|---|
Dexamethasone | Tab | 2 mg | 25.6 | 11.9 | |
Megestrol | Tab | 40 mg | 75.9 | 22.4 | |
Sol | 40 mg/ ml | 98.8 | 16.5 | ||
Sol | 625 mg/ 5 ml | 381.8 | 71.3 | ||
Megace ES | Sol | 625 mg/ 5 ml | 728.8 | 605.5 | |
Dronabinol | Cap | 2.5mg | 132.6 | 21.9 | |
Marinol | Cap | 2.5 mg | 388.9 | 330.7 | |
Syndros | Sol | 5 mg/ ml | 1439.9 | 1156.3 | |
Olanzapine | Tab | 5 mg | 91.4 | 4.5 | |
ODT | 5 mg | 148.8 | 12.5 | ||
Zyprexa | Tab | 5 mg | 268.4 | 223.7 | |
Zyprexa zydis | ODT | 5 mg | 270.4 | 238.4 | |
Mirtazapine | Tab | 15 mg | 20.4 | 4.5 | |
ODT | 15 mg | 34.8 | 12.4 | ||
Remeron | Tab | 15 mg | 117.0 | 90.9 | |
Remeron | ODT | 15 mg | 135.7 | 72.7 | |
Cyproheptadine | Tab | 4 mg | 53.7 | 11.9 | |
Metoclopramide | Tab | 5 mg | 16.2 | 8.9 | |
Reglan | Tab | 5 mg | 253.8 | 213.2 | |
ODT | 5 mg | 538.0 | 221.5 |
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Abstract Disclosures
Funded by Conquer Cancer
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