Discussing and prescribing expensive unfunded anticancer drugs in Australia — ASN Events
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Discussing and prescribing expensive unfunded anticancer drugs in Australia (#319)

Deme J Karikios 1 2 , Linda Mileshkin 3 , Andrew Martin 1 , Danielle Ferraro 4 , Martin Stockler 1 5 6
  1. NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
  2. Macarthur Cancer Therapy Centre, Campbelltown, NSW, Australia
  3. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  4. University of Melbourne, Melbourne, VIC, Australia
  5. Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia
  6. Chris O'Brien Lifehouse, Sydney, NSW, Australia

Background: The use of unfunded anticancer drugs entails substantial out-of-pocket costs for patients. We aimed to determine how frequently Australian medical oncologists discuss and prescribe unfunded anticancer drugs, and their attitudes and beliefs about their use.

Methods: Members of the Medical Oncology Group of Australia completed an online survey about their clinical practices over a recent 3 month period. Linear modelling was used to estimate the effects of respondent characteristics on the frequency of discussions about, and prescription of, unfunded anticancer drugs, after adjusting for clinical workload. 

Results:  The 154 respondents (27% of 575 members) included 30 trainees and had a median of 8 years in oncology practice (range 1 to 50).  All but one respondent reported discussing an unfunded anticancer drug at some time in the past, and 92% had discussed at least one in the previous 3 months.  93% reported prescribing an unfunded anticancer drug at some time in the past, and 68% reported prescribing at least one in the previous 3 months. Respondents reported discussing unfunded anticancer drugs with an average of 2.5 patients per month (95% CI 2.1 to 2.9), and prescribed them to an average of 0.9 patients per month (95% CI 0.7 to 1.2). Frequency of discussion and prescription were associated with private practice (p=0.01 and p=0.04) and urban location (p=0.02 and p=0.01).  Unfunded anticancer drugs were most frequently available via pharmaceutical company access programs.  Concerns about discussing and prescribing unfunded anticancer drugs rated most important were “potential to cause financial hardship” and “difficulty for patients to evaluate the benefits versus the costs”. 83% of respondents reported that out-of-pocket costs influence their willingness to prescribe an unfunded anticancer drug. 

Conclusions: Australian medical oncologists frequently discuss and prescribe unfunded anticancer drugs, and are concerned about causing financial hardship and difficult decisions for their patients. 

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