• Health Expenditure Trends in East Asian and Pacific Countries, 1995-2010

      Abraham, Ivo; Boytsova, Olga; Patel, Kinjal; Pham, Tina; Abraham, Ivo; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: To classify East Asian and Pacific countries into homogenous groups based on potential determinants of their healthcare expenditures and public health care. Methods: We used data from the 1995 to 2010 World Health Organization (WHO) database. Cluster analysis techniques were applied to identify clusters of East Asian and Pacific countries using variables identified as potential determinants of healthcare expenditures and public health care. Differences between clusters of countries were validated using Analysis of Variance (ANOVA). Average annual growth rate (AAGR) was calculated to study the change in trends across countries over time. Main Results: Nineteen countries with complete data were included. Of those, we identified four distinct clusters. Cluster 1 consisted of Cambodia, Laos, Mongolia, Solomon Islands, Timor-Leste and Vanuatu. Cluster 2 represented China, Myanmar, and Vietnam. Cluster 3 consisted of Fiji, Indonesia, South Korea, Malaysia and Thailand. Cluster 4 represented Micronesia, Papua New Guinea, Philippines, Samoa and Tonga. Health Expenditure per capita AAGR (P=0.002), infant mortality rate AAGR (P=0.018), life expectancy at birth AAGR (p=0.003), population ages 65 and above AAGR (P=0.004) and death rate (P<0.001) were found to be significantly different among the clusters. Clusters were similar based on birth rate (P=0.425) and public health expenditure (P=0.231), though there were trends of differences. Conclusion: East Asian and Pacific countries were similar based on birth rate and public health expenditure, but were different based on health expenditure per capita, infant mortality rate, life expectancy at birth, population ages 65 and above and death rate. Exploration of clusters among countries may increase the chances of success for health policies and innovations at lower costs of targeted implementation at a global level.
    • Perceptions of Healthcare Workers on the Cost and Safety of Oral Oncolytic Agents for Patients: A Survey of Healthcare Worker

      McBride, Ali; Abraham, Ivo; Tompkinson, Madeline; College of Pharmacy, The University of Arizona (The University of Arizona., 2018)
      Specific Aims: The number of newly approved agents continues to increase with over 800 new oncology agents in the pipeline and 25% of these being oral agents. Oral chemotherapy agents have advantages including patient convenience, prolonged drug exposure, and non-invasive administration. These advantages come at a premium that many patients cannot afford leading to change or therapy abandonment. Methods: This is a descriptive, non-experimental, cross-sectional study of healthcare professionals in hematology/oncology patient care across the United States. Data was collected using a 35-item online questionnaire to measure quality improvement areas when using oral chemotherapy agents. Results: Results of 503 survey respondents comprised of pharmacists (54%), physicians (5%), advanced practitioners (4%), nurses (10%), pharmacy administrators (15%), social workers (2%), and other professionals (9%). Treatment abandonment due to cost is seen by 46.6% of respondents. The most common agents abandoned due to cost included capecitabine, abiraterone, and palbociclib. Prior authorization delays occur in 1-2 patients weekly creating a 4-6 day wait to initiate therapy and 24.0% of respondents spend more than 30 hours weekly resolving these issues. The most utilized medication assistance programs include Manufacturer Assistance Programs, Disease-Based Foundations, and Manufacturer Co-Pay Cards. Conclusions: This survey addresses healthcare worker perspective on prevalence of and issues relative to chemotherapy and indicate a high incidence in abandonment of therapy, delay in therapy initiation, and significant resources allocated to issues associated with the cost of oral chemotherapy agents. Further evaluation is required to resolve issues in therapy and minimize impact on patient care.