INFLUENCE OF CRITICAL DISEASE INSURANCE (CDI) POLICY ON PEMETREXED ADHERENCE AMONG THE FIRST-LINE NON-SQUAMOUS NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS IN ZHEJIANG PROVINCE OF CHINA

To investigate the impact of Critical Disease Insurance(CDI) policy on pemetrexed adherence for non-squamous NSCLC first-line treatment in Zhejiang province of China and to explore factors associated with pemetrexed adherence after CDI. A retrospective data analysis was conducted using electronic medical records from Medbanks database between 1/2010 and 5/2017. Zhejiang residents, who were≥18 years old, diagnosed with stage IIIb/IV non-squamous NSCLC not eligible for surgery or radiotherapy, initiating their first-line therapy with pemetrexed monotherapy or pemetrexed/platinum doublets before 31/10/2016, were included. Pemetrexed adherence was measured by treatment cycles, which were described from periods before CDI(p1:before 4/2014; p2:5/2014-8/2014; p3:9/2014-12/2014) to periods after CDI(p4:1/2015-12/2015; p5:1/2016-11/2016). Two-sample T test, Chi-square test, trend test and multiple logistic regression were used to detect CDI impact on treatment cycles and factors associated with >4cycles pemetrexed treatment after CDI. A total of 353 patients were included. Percentage of patients with treatment cycles >4 increased from 17.4% to 39.1% (p<0.0001) and mean (SD) treatment cycles increased from 3.5(1.4) to 5.2(4.2) (before vs after CDI) (p<0.0001). Percentage of patients with treatment cycles >4 increased from 28%, 11.9%, 21.9% (p1-p3 before CDI) to 44.6% and 31.6% (p4 and p5 after CDI) (p=0.019). Similar increased trend from p1 to p5 was also found in CDI covered pemetrexed as 25.6%, 12.5%, 25%, 52% and 45.9%, respectively (p=0.0016). For patients with CDI covered pemetrexed, the odds of receiving >4 cycles treatment after CDI is 3.1 times as that of before CDI(p<0.0001). After CDI, higher likelihood of >4 cycles treatment was significantly associated with CDI-covered pemetrexed(vs other pemetrexed,OR:2.4,p=0.002) and females(vs male,OR:2.0,p=0.01). Zhejiang CDI policy has a positive impact on increasing pemetrexed treatment cycles for advanced non-squamous NSCLC patients. After CDI policy reduced economic burden, CDI-covered pemetrexed and female are two factors associated with better pemetrexed adherence.