Limited benefit and high financial burden of drugs used to manage cancer-associated anorexia/cachexia syndrome (CACS).

Authors

Arjun Gupta

Arjun Gupta

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

Organizations

Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, Louisiana State University Health Sciences Center, Shreveport, LA, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, University of Minnesota, Minneapolis, MN, University of Minnesota School of Public Health, Minneapolis, MN, The Ohio State University Comprehensive Cancer Center, Columbus, OH, The University of Texas MD Anderson Cancer Center, Houston, TX, Massachusetts General Hospital Cancer Center, Boston, MA, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, Vanderbilt University Medical Center, Nashville, TN

Research Funding

Conquer Cancer Foundation of the American Society of Clinical Oncology
Conquer Cancer Foundation of the American Society of Clinical Oncology

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 Details

Meeting

2021 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cost, Value, and Policy; Health Equity and Disparities; Patient Experience

Track

Cost, Value, and Policy,Technology and Innovation in Quality of Care,Health Care Access, Equity, and Disparities,Patient Experience,Quality, Safety, and Implementation Science

Sub Track

Value/Cost of Care

Citation

J Clin Oncol 39, 2021 (suppl 28; abstr 55)

DOI

10.1200/JCO.2020.39.28_suppl.55

Abstract #

55

Poster Bd #

B21

Abstract Disclosures

Funded by Conquer Cancer

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