Management of men with advanced prostate cancer has evolved to include urologists, made possible by oral targeted agents (eg, abiraterone or enzalutamide) that can be dispensed directly to patients in the office. We sought to investigate whether this increasingly common model improves access to these agents, especially for Black men who are historically undertreated.
We used 20% national Medicare data to perform a retrospective cohort study of men with advanced prostate cancer from 2011 through 2019, managed by urology practices with and without in-office dispensing. Using a difference-in-difference framework, generalized estimating equations were used to measure the effect of in-office dispensing on prescriptions for abiraterone and/or enzalutamide, adjusting for differences between patients, including race.
New prescription fills for oral targeted agents increased after the adoption of in-office dispensing (+4.4%, 95% confidence interval [95%CI] 3.4% to 5.4%) relative to that for men managed by practices without dispensing (+2.4% [95%CI 1.4% to 3.4%]). The increase in the post-intervention period (difference-in-difference estimate) was 2% higher (95%CI +0.6% to + 3.4%) for men managed by practices adopting dispensing relative to controls. The effect was strongest for practices adopting dispensing in 2015 (difference-in-difference estimate: +4.2% [95%CI +2.3% to + 6.2%]). The effect of dispensing adoption did not differ by race.
Adoption of in-office dispensing by urology practices increased prescription fills for oral targeted agents in men with advanced prostate cancer. This model of delivery may improve access to this important class of medications.
JNCI cancer spectrum. 2023 Aug 29 [Epub ahead of print]
Dawson Hill, Samuel R Kaufman, Mary K Oerline, Kassem Faraj, Megan E V Caram, Vahakn B Shahinian, Brent K Hollenbeck, Avinash Maganty
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA., Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.