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Published in: BMC Cancer 1/2012

Open Access 01-12-2012 | Research article

Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey

Authors: Yuko Kodama, Ryoko Morozumi, Tomoko Matsumura, Yukiko Kishi, Naoko Murashige, Yuji Tanaka, Morihito Takita, Nobuyo Hatanaka, Eiji Kusumi, Masahiro Kami, Akihiko Matsui

Published in: BMC Cancer | Issue 1/2012

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Abstract

Background

The financial burden of medical expenses has been increasing for cancer patients. We investigated the relationship between household income and financial burden among patients with chronic myelogenous leukaemia (CML) who have been treated with imatinib.

Methods

A questionnaire was distributed to 1200 patients between May and August 2009. We retrospectively surveyed their household incomes, out-of-pocket medical expenses, final co-payments after refunds, and the perceived financial burden of their medical expenses in 2000, 2005 and 2008.

Results

A total of 577 patients completed the questionnaire. Their median age was 61 years (range, 15–94). A financial burden was felt by 41.2 % (28 of 68) of the patients treated with imatinib in 2000, 70.8 % (201 of 284) in 2005, and 75.8 % (400 of 528) in 2008. Overall, 182 patients (31.7 %) considered its discontinuation because of the financial burden and 15 (2.6 %) temporarily stopped their imatinib prescription. In 2000, 2005 and 2008, the patients’ median annual household incomes were 49,615 US Dollars (USD), 38,510 USD and 36,731 USD, respectively, with an average currency exchange rate of 104 Yen/USD in 2008. Their median annual out-of-pocket expenses were 11,548, 12,067 and 11,538 USD and their median final annual co-payments were 4,375, 4,327 and 3,558 USD, respectively. Older patients (OR = 0.96, 95 % CI: 0.95–0.98, p ≪ 0.0001 for 1-year increments), and patients with higher household incomes (OR = 0.92, 95 % CI: 0.85–0.99, p = 0.03 for 10,000 USD-increments) were less likely to have considered discontinuing their imatinib treatment. Conversely, patients with higher annual final co-payments (OR = 2.21, 95 % CI: 1.28–4.28, p = 0.004 for 10,000 USD-increments) were more likely to have considered discontinuing their imatinib treatment.

Conclusions

The proportion of CML patients who sensed a financial burden increased between 2000 and 2008. During this period, their annual incomes fell by 13,000 USD, although their medical expenses did not change. Financial support for patients being treated with expensive drugs remains a major problem in Japan.
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Literature
1.
go back to reference Mason A, Drummond M, Ramsey S, Campbell J, Raisch D: Comparison of anticancer drug coverage decisions in the United States and United Kingdom: does the evidence support the rhetoric?. J Clin Oncol. 2010, 28: 3234-3238. 10.1200/JCO.2009.26.2758.CrossRefPubMed Mason A, Drummond M, Ramsey S, Campbell J, Raisch D: Comparison of anticancer drug coverage decisions in the United States and United Kingdom: does the evidence support the rhetoric?. J Clin Oncol. 2010, 28: 3234-3238. 10.1200/JCO.2009.26.2758.CrossRefPubMed
2.
go back to reference Mileshkin L, Schofield PE, Jefford M, Agalianos E, Levine M, Herschtal A, Savulescu J, Thomson JA, Zalcberg JR: To tell or not to tell: the community wants to know about expensive anticancer drugs as a potential treatment option. J Clin Oncol. 2009, 27: 5830-5837. 10.1200/JCO.2009.22.7793.CrossRefPubMed Mileshkin L, Schofield PE, Jefford M, Agalianos E, Levine M, Herschtal A, Savulescu J, Thomson JA, Zalcberg JR: To tell or not to tell: the community wants to know about expensive anticancer drugs as a potential treatment option. J Clin Oncol. 2009, 27: 5830-5837. 10.1200/JCO.2009.22.7793.CrossRefPubMed
3.
go back to reference Wolfe F, Michaud K: Out-of-pocket expenses and their burden in patients with rheumatoid arthritis. Arthritis Rheum. 2009, 61: 1563-1570. 10.1002/art.24724.CrossRefPubMed Wolfe F, Michaud K: Out-of-pocket expenses and their burden in patients with rheumatoid arthritis. Arthritis Rheum. 2009, 61: 1563-1570. 10.1002/art.24724.CrossRefPubMed
4.
go back to reference Ikegami N, Yoo BK, Hashimoto H, Matsumoto M, Ogata H, Babazono A, Watanabe R, Shibuya K, Yang BM, Reich MR, Kobayashi Y: Japanese universal health coverage:evolution, achievements, and challenges. Lancet. 2011, 378: 1106-1115. 10.1016/S0140-6736(11)60828-3.CrossRefPubMed Ikegami N, Yoo BK, Hashimoto H, Matsumoto M, Ogata H, Babazono A, Watanabe R, Shibuya K, Yang BM, Reich MR, Kobayashi Y: Japanese universal health coverage:evolution, achievements, and challenges. Lancet. 2011, 378: 1106-1115. 10.1016/S0140-6736(11)60828-3.CrossRefPubMed
5.
go back to reference Shiroiwa T, Fukuda T, Tsutani K: Out-of-pocket payment and cost-effectiveness of XELOX and XELOX plus bevacizumab therapy: from the perspective of metastatic colorectal cancer patients in Japan. Int J Clin Oncol. 2010, 15: 256-262. 10.1007/s10147-010-0045-x.CrossRefPubMed Shiroiwa T, Fukuda T, Tsutani K: Out-of-pocket payment and cost-effectiveness of XELOX and XELOX plus bevacizumab therapy: from the perspective of metastatic colorectal cancer patients in Japan. Int J Clin Oncol. 2010, 15: 256-262. 10.1007/s10147-010-0045-x.CrossRefPubMed
6.
go back to reference Druker BJ, Tamura S, Buchdunger E, Ohno S, Segal GM, Fanning S, Zimmermann J, Lydon NB: Effects of a selective inhibitor of the Abl tyrosine kinase on the growth of Bcr-Abl positive cells. Nat Med. 1996, 2: 561-566. 10.1038/nm0596-561.CrossRefPubMed Druker BJ, Tamura S, Buchdunger E, Ohno S, Segal GM, Fanning S, Zimmermann J, Lydon NB: Effects of a selective inhibitor of the Abl tyrosine kinase on the growth of Bcr-Abl positive cells. Nat Med. 1996, 2: 561-566. 10.1038/nm0596-561.CrossRefPubMed
7.
go back to reference Druker BJ, Talpaz M, Resta DJ, Peng B, Buchdunger E, Ford JM, Lydon NB, Kantarjian H, Capdeville R, Ohno-Jones S, Sawyers CL: Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med. 2001, 344: 1031-1037. 10.1056/NEJM200104053441401.CrossRefPubMed Druker BJ, Talpaz M, Resta DJ, Peng B, Buchdunger E, Ford JM, Lydon NB, Kantarjian H, Capdeville R, Ohno-Jones S, Sawyers CL: Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med. 2001, 344: 1031-1037. 10.1056/NEJM200104053441401.CrossRefPubMed
8.
go back to reference Druker BJ, Guilhot F, O’Brien SG, Gathmann I, Kantarjian H, Gattermann N, Deininger MW, Silver RT, Goldman JM, Stone RM, Cervantes F, Hochhaus A, Powell BL, Gabrilove JL, Rousselot P, Reiffers J, Cornelissen JJ, Hughes T, Agis H, Fischer T, Verhoef G, Shepherd J, Saglio G, Gratwohl A, Nielsen JL, Radich JP, Simonsson B, Taylor K, Baccarani M, So C, et al: Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med. 2006, 355: 2408-2417. 10.1056/NEJMoa062867.CrossRefPubMed Druker BJ, Guilhot F, O’Brien SG, Gathmann I, Kantarjian H, Gattermann N, Deininger MW, Silver RT, Goldman JM, Stone RM, Cervantes F, Hochhaus A, Powell BL, Gabrilove JL, Rousselot P, Reiffers J, Cornelissen JJ, Hughes T, Agis H, Fischer T, Verhoef G, Shepherd J, Saglio G, Gratwohl A, Nielsen JL, Radich JP, Simonsson B, Taylor K, Baccarani M, So C, et al: Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med. 2006, 355: 2408-2417. 10.1056/NEJMoa062867.CrossRefPubMed
9.
go back to reference Sakai M, Miyazaki Y, Matsuo E, Moriuchi Y, Hata T, Fukushima T, Imaizumi Y, Imanishi D, Taguchi J, Iwanaga M, Tsushima H, Inoue Y, Takasaki Y, Tsuchiya T, Komoda M, Ando K, Horio K, Moriwaki Y, Tominaga S, Itonaga H, Nagai K, Tsukasaki K, Tsutsumi C, Sawayama Y, Yamasaki R, Ogawa D, Kawaguchi Y, Ikeda S, Yoshida S, Onimaru Y, et al: Long-term efficacy of imatinib in a practical setting is correlated with imatinib trough concentration that is influenced by body size: a report by the Nagasaki CML Study Group. Int J Hematol. 2009, 89: 319-325. 10.1007/s12185-009-0263-z.CrossRefPubMed Sakai M, Miyazaki Y, Matsuo E, Moriuchi Y, Hata T, Fukushima T, Imaizumi Y, Imanishi D, Taguchi J, Iwanaga M, Tsushima H, Inoue Y, Takasaki Y, Tsuchiya T, Komoda M, Ando K, Horio K, Moriwaki Y, Tominaga S, Itonaga H, Nagai K, Tsukasaki K, Tsutsumi C, Sawayama Y, Yamasaki R, Ogawa D, Kawaguchi Y, Ikeda S, Yoshida S, Onimaru Y, et al: Long-term efficacy of imatinib in a practical setting is correlated with imatinib trough concentration that is influenced by body size: a report by the Nagasaki CML Study Group. Int J Hematol. 2009, 89: 319-325. 10.1007/s12185-009-0263-z.CrossRefPubMed
10.
go back to reference Hahn EA, Glendenning GA, Sorensen MV, Hudgens SA, Druker BJ, Guilhot F, Larson RA, O’Brien SG, Dobrez DG, Hensley ML, Cella D, IRIS Investigators: Quality of life in patients with newly diagnosed chronic phase chronic myeloid leukemia on imatinib versus interferon alfa plus low-dose cytarabine: results from the IRIS Study. J Clin Oncol. 2003, 21: 2138-2146. 10.1200/JCO.2003.12.154.CrossRefPubMed Hahn EA, Glendenning GA, Sorensen MV, Hudgens SA, Druker BJ, Guilhot F, Larson RA, O’Brien SG, Dobrez DG, Hensley ML, Cella D, IRIS Investigators: Quality of life in patients with newly diagnosed chronic phase chronic myeloid leukemia on imatinib versus interferon alfa plus low-dose cytarabine: results from the IRIS Study. J Clin Oncol. 2003, 21: 2138-2146. 10.1200/JCO.2003.12.154.CrossRefPubMed
11.
go back to reference Thompson Healthcare: Red Book: Pharmacy’s Fundamental Reference. 2008, Montvale, NJ: Thompson Healthcare Thompson Healthcare: Red Book: Pharmacy’s Fundamental Reference. 2008, Montvale, NJ: Thompson Healthcare
12.
go back to reference Bennett MI, Closs SJ, Chatwin J: Cancer pain management at home (I): do older patients experience less effective management than younger patients?. Support Care Cancer. 2009, 17: 787-792. 10.1007/s00520-008-0549-3.CrossRefPubMed Bennett MI, Closs SJ, Chatwin J: Cancer pain management at home (I): do older patients experience less effective management than younger patients?. Support Care Cancer. 2009, 17: 787-792. 10.1007/s00520-008-0549-3.CrossRefPubMed
14.
go back to reference Kelley RK, Venook AP: Nonadherence to imatinib during an economic downturn. N Engl J Med. 2010, 363: 596-598. 10.1056/NEJMc1004656.CrossRefPubMed Kelley RK, Venook AP: Nonadherence to imatinib during an economic downturn. N Engl J Med. 2010, 363: 596-598. 10.1056/NEJMc1004656.CrossRefPubMed
15.
go back to reference Darkow T, Henk HJ, Thomas SK, Feng W, Baladi JF, Goldberg GA, Hatfield A, Cortes J: Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia. Pharmacoeconomics. 2007, 25: 481-496. 10.2165/00019053-200725060-00004.CrossRefPubMed Darkow T, Henk HJ, Thomas SK, Feng W, Baladi JF, Goldberg GA, Hatfield A, Cortes J: Treatment interruptions and non-adherence with imatinib and associated healthcare costs: a retrospective analysis among managed care patients with chronic myelogenous leukaemia. Pharmacoeconomics. 2007, 25: 481-496. 10.2165/00019053-200725060-00004.CrossRefPubMed
18.
go back to reference Mehnert A: Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011, 77: 109-130. 10.1016/j.critrevonc.2010.01.004.CrossRefPubMed Mehnert A: Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011, 77: 109-130. 10.1016/j.critrevonc.2010.01.004.CrossRefPubMed
20.
go back to reference Au WY, Caguioa PB, Chuah C, Hsu SC, Jootar S, Kim DW, Kweon IY, O’Neil WM, Saikia TK, Wang J: Chronic myeloid leukemia in Asia. Int J Hematol. 2009, 89: 14-23. 10.1007/s12185-008-0230-0.CrossRefPubMed Au WY, Caguioa PB, Chuah C, Hsu SC, Jootar S, Kim DW, Kweon IY, O’Neil WM, Saikia TK, Wang J: Chronic myeloid leukemia in Asia. Int J Hematol. 2009, 89: 14-23. 10.1007/s12185-008-0230-0.CrossRefPubMed
21.
go back to reference Baccarani M, Cortes J, Pane F, Niederwieser D, Saglio G, Apperley J, Cervantes F, Deininger M, Gratwohl A, Guilhot F, Hochhaus A, Horowitz M, Hughes T, Kantarjian H, Larson R, Radich J, Simonsson B, Silver RT, Goldman J, Hehlmann R: European LeukemiaNet. Chronic myeloid leukemia: an update of concepts and management recommendations of European LeukemiaNet. J Clin Oncol. 2009, 27: 6041-6051. 10.1200/JCO.2009.25.0779.CrossRefPubMed Baccarani M, Cortes J, Pane F, Niederwieser D, Saglio G, Apperley J, Cervantes F, Deininger M, Gratwohl A, Guilhot F, Hochhaus A, Horowitz M, Hughes T, Kantarjian H, Larson R, Radich J, Simonsson B, Silver RT, Goldman J, Hehlmann R: European LeukemiaNet. Chronic myeloid leukemia: an update of concepts and management recommendations of European LeukemiaNet. J Clin Oncol. 2009, 27: 6041-6051. 10.1200/JCO.2009.25.0779.CrossRefPubMed
22.
go back to reference Saglio G, Kim DW, Issaragrisil S, le Coutre P, Etienne G, Lobo C, Pasquini R, Clark RE, Hochhaus A, Hughes TP, Gallagher N, Hoenekopp A, Dong M, Haque A, Larson RA, Kantarjian HM, ENESTnd Investigators: Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med. 2010, 362: 2251-2259. 10.1056/NEJMoa0912614.CrossRefPubMed Saglio G, Kim DW, Issaragrisil S, le Coutre P, Etienne G, Lobo C, Pasquini R, Clark RE, Hochhaus A, Hughes TP, Gallagher N, Hoenekopp A, Dong M, Haque A, Larson RA, Kantarjian HM, ENESTnd Investigators: Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med. 2010, 362: 2251-2259. 10.1056/NEJMoa0912614.CrossRefPubMed
23.
go back to reference Kantarjian H, Shah NP, Hochhaus A, Cortes J, Shah S, Ayala M, Moiraghi B, Shen Z, Mayer J, Pasquini R, Nakamae H, Huguet F, Boqué C, Chuah C, Bleickardt E, Bradley-Garelik MB, Zhu C, Szatrowski T, Shapiro D, Baccarani M: Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2010, 362: 2260-2270. 10.1056/NEJMoa1002315.CrossRefPubMed Kantarjian H, Shah NP, Hochhaus A, Cortes J, Shah S, Ayala M, Moiraghi B, Shen Z, Mayer J, Pasquini R, Nakamae H, Huguet F, Boqué C, Chuah C, Bleickardt E, Bradley-Garelik MB, Zhu C, Szatrowski T, Shapiro D, Baccarani M: Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2010, 362: 2260-2270. 10.1056/NEJMoa1002315.CrossRefPubMed
25.
go back to reference Kawaguchi T, Hamada A, Hirayama C, Nakashima R, Nambu T, Yamakawa Y, Watanabe H, Horikawa K, Mitsuya H, Saito H: Relationship between an effective dose of imatinib, body surface area, and trough drug levels in patients with chronic myeloid leukemia. Int J Hematol. 2009, 89: 642-648. 10.1007/s12185-009-0315-4.CrossRefPubMed Kawaguchi T, Hamada A, Hirayama C, Nakashima R, Nambu T, Yamakawa Y, Watanabe H, Horikawa K, Mitsuya H, Saito H: Relationship between an effective dose of imatinib, body surface area, and trough drug levels in patients with chronic myeloid leukemia. Int J Hematol. 2009, 89: 642-648. 10.1007/s12185-009-0315-4.CrossRefPubMed
Metadata
Title
Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey
Authors
Yuko Kodama
Ryoko Morozumi
Tomoko Matsumura
Yukiko Kishi
Naoko Murashige
Yuji Tanaka
Morihito Takita
Nobuyo Hatanaka
Eiji Kusumi
Masahiro Kami
Akihiko Matsui
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2012
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-12-152

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