Objective  To understand the current situation of a patient management service and evaluate its effect in direct-to-patient (DTP) pharmacies. Method  This is a retrospective cohort study using real-world data routinely collected from DTP pharmacies. A cohort of lung cancer patients using PD-1/L1 was retrospectively established using sales and follow-up data which were collected from 79 Medbanks DTP pharmacies during their daily business activities. Cox regression analysis was used to explore the factors associated with the durations of drug purchase and follow-up. Result  A total of 12,226 subjects were included in this study, 76.4% of them were male, with a median age of 62 years. Across the total study population, 1,902 (15.56%) were described as low follow-up response rate group, 1,448 (11.84%) were described as middle follow-up response rate group and 8,876 (72.60%) as high follow-up response rate group. Statistically significant differences were observed in both median drug purchase duration and follow-up duration across the three groups. Findings from Cox regression analysis indicated that factors associated with longer duration of drug purchase included participating a patient access program (HR=0.873, P<0.001), experiencing adverse events during follow-up (HR=0.761, P<0.001) and having a follow-up response rate greater than 70% (HR=0.790, P<0.001). Factors associated with longer follow-up duration included participating in a patient access program (HR=0.535, P<0.001), having experienced adverse events during follow-up (HR=0.689, P<0.001), reporting adverse events during the last follow-up (HR=0.763, P<0.001) and having a higher follow-up response rate (30-70%: HR=0.688, P<0.001;>70%: HR=0. 579, P<0.001). Conclusion  Patient management services provided by the DTP pharmacies may play an active role in extending the duration of PD-1/L1 utilization and patient follow-up. 

1.杨显辉, 张晓霞. 我国DTP 药房的SWOT分析及发展建议[J]. 中国药事, 2015, 29(3): 329-331. DOI: 10.16153/j.1002-7777.2015.03.021. [Yang XH, Zhang XX. SWOT analysis and development suggestion on DTP pharmacy in China[J]. China Academic Journal Electronic Publishing House, 2015, 29(3): 329-331.]

2.钱珍光, 王艳翚, 朱艳娇, 等. 医药分开背景下我国DTP 药房模式的延展性研究[J]. 中国卫生事业管理, 2019, 36(5): 357-359, 369. DOI: CNKI:SUN:ZWSG.0. 2019-05-014. [Qian ZG, Wang YH, Zhu YJ, et al. Studying on the extensibility of DTP pharmacy model in China under the background of separation of clinic from pharmacy[J]. The Chinese Health Service Management, 2019, 36(5): 357-359, 369.]

3.王丹丹, 姚峥嵘, 王艳翚, 等. 医药分开视角下我国DTP药房模式的发展[J]. 卫生经济研究, 2018, (7): 9-11. DOI: 10.14055/j.cnki.33-1056/f.2018.07.003. [Wang DD, Yao ZR, Wang YH, et al. The development of DTP pharmacy model in China from the perspective of clinic and pharmacy separation[J]. Health Economics Research, 2018, (7): 9-11.]

4.Sawicki C, Friend KE, Patel R, et al. Two-way clinical messaging in a cml specialty pharmacy service model[J]. J Manag Care Spec Pharm, 2019, 25(11): 1290-1296. DOI: 10.18553/jmcp.2019.25.11.1290.

5.Wu EQ, Johnson S, Beaulieu N, et al. Health care resource utilization and costs associated with non-adherence to imatinib treatment in chronic myeloid leukemia patients[J]. Curr Med Res Opin, 2010, 26(1): 61-69. DOI: 10.1185/03007990903396469.

6.Ganesan P, Sagar TG, Dubashi B et al. Nonadherence to imatinib adversely affects event free survival in chronic phase chronic myeloid leukemia[J]. Am J Hematol, 2011, 86(6): 471-474. DOI: 10.1002/ajh.22019. 

7.Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer[J]. Breast Cancer Res Treat, 2011, 126(2): 529-537. DOI: 10.1007/s10549-010-1132-4.

8.McCowan C, Wang S, Thompson AM, et al. The value of high adherence to tamoxifen in women with breast cancer: a community-based cohort study[J]. Br J Cancer, 2013, 109(5): 1172-1180. DOI: 10.1038/bjc.2013.464.

9.Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small cell lung cancer[J]. N Engl J Med, 2015, 373(17): 1627-1639. DOI: 10.1056/NEJMoa1507643.

10.Ethan B, Allison MD, Amylou CD, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment[J]. JAMA, 2017, 318(2): 197-198. DOI: 10.1001/jama.2017. 7156.

11.Cortellini A, Chiari R, Ricciuti B, et al. Correlations between the immune-related adverse events spectrum and efficacy of anti-PD1 immunotherapy in NSCLC patients[J]. Clin Lung Cancer, 2019, 20(4): 237-247. DOI: 10.1016/j.cllc.2019.02.006.

12.Teraoka S, Fujimoto D, Morimoto T, et al. Early immune-related adverse events and association with outcome in advanced non-small cell lung cancer patients treated with nivolumab: a prospective cohort study[J]. J Thorac Oncol, 2017, 12(12): 1798-1805. DOI: 10.1016/j.jtho.2017. 08.022.

13.Weber JS, Hodi FS, Wolchok JD, et al. Safety profile of nivolumab monotherapy: a pooled analysis of patients with advanced melanoma[J]. J Clin Oncol, 2017, 35(7): 785-792. DOI: 10.1200/JCO.2015.66.1389. 

14.Sanlorenzo M, Vujic I, Daud A, et al. Pembrolizumab cutaneous adverse events and their association with disease progression[J]. JAMA Dermatol, 2015, 151(11): 1206-1212. DOI: 10.1001/jamadermatol.2015.1916.

15.Ksienski D, Wai ES, Croteau N, et al. Efficacy of nivolumab and pembrolizumab in patients with advanced non-small-cell lung cancer needing treatment interruption because of adverse events: a retrospective multicenter analysis[J]. Clin Lung Cancer, 2019, 20(1): e97-e106. DOI: 10.1016/j.cllc.2018.09.005.