The Impact of Medication Adherence on Total Treatment Costs in Patients with Non-Small Cell Lung Carcinoma
DOI:
https://doi.org/10.36497/jri.v46i1.1024Keywords:
adherence, NSCLC, targeted therapy, total treatment costAbstract
Background: Lung cancer is the leading cause of cancer-related death globally and ranks second in cancer incidence in Indonesia. Targeted therapies such as Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs) and Anaplastic Lymphoma Kinase (ALK) inhibitors are recommended for advanced-stage non-small cell lung cancer (NSCLC) but may be limited by high cost. This study aimed to assess the relationship between medication adherence—measured by the mean proportion ratio (MPR)—and total treatment costs, and to examine its association with patient-specific factors.
Methods: This observational, cross-sectional study used secondary data from NSCLC patients treated with EGFR-TKIs or ALK inhibitors at a Cancer Center in Jakarta, Indonesia (January 2023-March 2025). Eighty-six eligible patients (aged ≥18 years) were diagnosed with NSCLC, confirmed by immunohistochemistry (EGFR or ALK-positive). MPR measured medication adherence and analysed using Mann-Whitney and chi-square tests using SPSS Version 23, with a value of P<0.05 being significant.
Results: Among NSCLC patients, about 89.53% exhibited a high level of treatment adherence, with an MPR score ≥0.8. Most patients were female (62.8%), under 60 years old (51.2%), stage IV (74.4%), and had an EGFR exon 19 mutation (52.3%). Osimertinib (30.2%) and Afatinib (24.4%) were the most used therapies. Most patients reported no serious side effects (57.0%) and received caregiver support (57.0%). There was no significant association between medication adherence and treatment cost (P=0.955), nor patient-related factors.
Conclusion: Approximately 9 out of 10 NSCLC patients adhere to treatment with EGFR-TKIs or ALK inhibitors. High levels of adherence did not significantly increase additional medical expenses that would raise the total cost of treatment. Further qualitative research is needed to explore adherence determinants.
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References
1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–63.
2. World Health Organization. Cancer [Internet]. 2022 [cited 2023 Dec 26]. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer
3. Global Cancer Observatory. Indonesia: Statistics at a glance, 2022. World Health Organization; 2022.
4. Samol J, Demedts I, Erman M, Kozlov V, Minatta JN, Moiseenko FV, et al. 26P Real-world use of tyrosine kinase inhibitors (TKI) in epidermal growth factor receptor mutated (EGFRm) advanced non-small cell lung cancer (NSCLC) in nine countries. J Thorac Oncol. 2023;18(4):S55-6.
5. Li X, Xia Y, Wang C, Huang S, Chu Q. Efficacy of ALK inhibitors in Asian patients with ALK inhibitor-naïve advanced ALK-positive non-small cell lung cancer: A systematic review and network meta-analysis. Transl Lung Cancer Res. 2024;13(8):2015–22.
6. Carrington C. Oral targeted therapy for cancer. Aust Prescr. 2015;38(5):171–6.
7. Menteri Kesehatan Republik Indonesia. Keputusan menteri kesehatan Republik Indonesia tentang pedoman nasional pelayanan kedokteran tata laksana kanker paru. Kementerian Kesehatan Republik Indonesia. Indonesia; 2023.
8. Jacobs JM, Ream ME, Pensak N, Nisotel LE, Fishbein JN, MacDonald JJ, et al. Patient experiences with oral chemotherapy: Adherence, symptoms, and quality of life. JNCCN. 2019;17(3):221–8.
9. Pedroso M, Grigoletto I, Oliveira L, Martins S, Costa L, Pozo K, et al. Adherence to exercise in people with lung or head and neck cancer: Self-reported symptoms and motivation during cancer treatment need to be considered. J Clin Med. 2024;13(20):6267.
10. Anghel LA, Farcas AM, Oprean RN. An overview of the common methods used to measure treatment adherence. Med Pharm Rep. 2019;92(2):117–22.
11. Tang KL, Quan H, Rabi DM. Measuring medication adherence in patients with incident hypertension: A retrospective cohort study. BMC Health Serv Res. 2017;17(1):135.
12. Tan AC, Tan DSW. Targeted therapies for lung cancer patients with oncogenic driver molecular alterations. J Clin Oncol. 2022;40(6):611–25.
13. National Comprehensive Cancer Network. Non-small cell lung cancer: Continue NCCN guidelines panel disclosures [Internet]. 2024 [cited 2024 Aug 25]. Available from: https://www.nccn.org/guidelines/guidelines-panels-and-disclosure/disclosure-policies-and-potential-conflicts-of-interest
14. da Silva GT, Bergmann A, Thuler LCS. Incidence and risk factors for bone metastasis in non-small cell lung cancer. Asian Pac J Cancer Prev. 2019;20(1):45–51.
15. Wang L, Wang W. Safety and efficacy of anaplastic lymphoma kinase tyrosine kinase inhibitors in non small cell lung cancer (Review). Oncol Rep. 2020;45(1):13–28.
16. da Rocha ADF, Berbert MCB, Martins VB. Relation between risk of dysphagia and oral intake level in cancer patients. Codas. 2025;37(2):e20240100.
17. Alfian SD, Griselda M, Pratama MAA, Insani WN, Abdulah R, Wawruch M. Factors influencing medication non-adherence in patients with chronic diseases and disabilities: Insights from a National Survey in Indonesia. Patient Prefer Adherence. 2025;19:1557–72.
18. Cohen J, Lee C, Markham R, Szerwo J, Roska M, Bubalo J. Medication use process and assessment of extemporaneous compounding and alternative routes of administration of oral oncology drugs: Guidance for clinical and oncology pharmacists. JACCP. 2022;5(11):1176–228.
19. Tian F, Chen Z, Tang R, Feng Q, Wu F. Impact of the expert consensus on polypharmacy and potentially inappropriate medication use in elderly lung cancer outpatients with multimorbidity: An interrupted time series analysis, 2016–2021. Front Pharmacol. 2022;13:992394.
20. Zhou H, Wang X, Yu D, Du R, Wang H, Zhu J, et al. Adherence to oral targeted anti-lung cancer therapy: A qualitative interview study. Patient Prefer Adherence. 2022;16:995–1004.
21. Kapagan T, Bulut N, Erdem GU. Polypharmacy and drug-drug interactions in metastatic breast cancer patients receiving cyclin-dependent kinase (CDK) 4/6 inhibitors. J Oncol Pharm Pract. 2024;30(8):1403–10.
22. Conley CC, McIntyre MK, Pensak NA, Lynce F, Graham D, Ismail-Khan R, et al. Barriers and facilitators to taking CDK4/6 inhibitors among patients with metastatic breast cancer: A qualitative study. Breast Cancer Res Treat. 2022;192(2):385–99.
23. Tokdemir G, Kav S. The effect of structured education to patients receiving oral agents for cancer treatment on medication adherence and self-efficacy. Asia Pac J Oncol Nurs. 2017;4(4):290–8.
24. Caram MEV, Oerline MK, Dusetzina S, Herrel LA, Modi PK, Kaufman SR, et al. Adherence and out-of-pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer. Cancer. 2020;126(23):5050–9.
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