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June 20, 2019

Interventional Pharmacoeconomics—A New Discipline for a Cost-Constrained Environment

Author Affiliations
  • 1Department of Medicine, The University of Chicago, Chicago, Illinois
  • 2Value in Cancer Care Consortium, Ann Arbor, Michigan
  • 3Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
JAMA Oncol. Published online June 20, 2019. doi:10.1001/jamaoncol.2019.1341

Pharmacoeconomics is an observational science usually focused on the value and affordability of pharmaceutical interventions. We now propose the concept of interventional pharmacoeconomics (IVPE), actively seeking to disruptively decrease prescribing costs through the development of new dosing regimens while maintaining equivalent efficacy.

There are at least 4 strategies for IVPE. The first strategy is lower doses. Several examples exist in which dose reduction is possible while maintaining efficacy. Many oral oncology drugs with poor bioavailability have been developed and labeled to be taken under fasting conditions. Proof of concept of this strategy was recently demonstrated for abiraterone.1 In that prospective trial,1 72 patients were randomized to the standard daily dose of 1000 mg of abiraterone fasting or 250 mg with food. Although the primary end point of noninferiority of prostate-specific antigen change was met, there was also evidence of equivalence of target (CYP17A) inhibition and prostate-specific antigen progression-free survival.

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