Healthcare costs,treatment patterns,and resource utilization among pancreatic cancer patients in a managed care population

Abstract

Background:

Pancreatic adenocarcinoma has few effective treatment options and poor survival. The objective of this study was to characterize treatment patterns and estimate the costs and resource use associated with its treatment in a commercially-insured US population.

Methods:

In this retrospective claims-based analysis, individuals ≥18 years old with evidence of pancreatic adenocarcinoma between January 1, 2001 and December 31, 2010 were selected from a managed care database. Treatment phase (either initial non-metastatic or metastatic) was determined using a claims-based algorithm. Patients in the pancreatic cancer population were matched 1:3 to a control population. Resource use (events/person-years), treatment patterns, and healthcare costs (per-patient per-month, PPPM) were determined during a variable length follow-up period (from first pancreatic cancer diagnosis to earliest of death, disenrollment, or study end).

Results:

In this study, 5262 pancreatic cancer patients were matched to 15,786 controls. Rates of office visits, inpatient visits, ER visits, and inpatient stays, and mean total all-cause healthcare costs PPPM ($15,480 vs $1001) were significantly higher among cancer patients than controls (all p?<?0.001). Mean inpatient costs were the single largest cost driver ($9917 PPPM). Also, mean total all-cause healthcare costs were significantly higher during the metastatic treatment phase vs the initial treatment phase of non-metastatic disease ($21,637 vs $10,358, p?<?0.001).

Conclusions:

These results indicate that pancreatic cancer imposes a substantial burden on the US healthcare system, and that treatment of more advanced disease is significantly more costly than initial treatment of non-metastatic disease.

Limitations:

Additional research is needed to validate the accuracy of the claims-based algorithms used to identify the treatment phase.     

Economic analysis of bevacizumab,cetuximab, and panitumumab with fluoropyrimidine-based chemotherapy in the first-line treatment of KRAS wild-type metastatic colorectal cancer (mCRC)

Abstract

Objective:

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Canada (excluding non-melanoma skin cancers). Bevacizumab is a recombinant humanized monoclonal antibody that selectively binds to human vascular endothelial growth factor. A sub-study confirmed its effectiveness in KRAS wild-type patients. Recent evidence has shown clinical benefit from anti-epidermal growth factor treatments cetuximab and panitumumab in these patients. The cost-effectiveness, to the Canadian healthcare system, of fluoropyrimidine-based chemotherapy (FBC) in combination with bevacizumab, cetuximab, or panitumumab was assessed for first-line treatment of KRAS wild-type mCRC patients.

Methods:

A Markov model was developed and calibrated to progression-free/overall survival, using separately reported trial survival and adverse event results for each comparator. Health-state resource utilization was derived from published data and oncologist input. Utilities and unit prices were obtained from published literature and standard Canadian sources.

Results:

Results per patient are over a lifetime horizon, to a maximum of 10 years, with 5% annual discounting. Comparators are ordered by total cost and the incremental cost-effectiveness ratio (ICER) of each is determined against the previous non-dominated therapy. Compared to FBC alone, bevacizumab?+?FBC has an ICER of $131,600 per QALY gained. Compared to bevacizumab?+?FBC, panitumumab?+?FBC is dominated and cetuximab?+?FBC has an ICER of $3.8 million per QALY. In probabilistic sensitivity analysis, bevacizumab?+?FBC had ～100%, ～100%, and 98.9% probabilities of being more cost-effective than both of the other combination treatments at thresholds of $50,000/QALY, $100,000/QALY, and $200,000/QALY, respectively.

Conclusion:

For first-line treatment of KRAS-WT mCRC, bevacizumab?+?FBC is associated with substantially lower costs as compared to panitumumab?+?FBC or cetuximab?+?FBC. Key limitations were that survival curves and adverse event rates were taken from separate clinical trials and that an indirect comparison was not included. Given these findings, bevacizumab is likely to offer the best value for money for this patient population.     

非小细胞肺癌靶向治疗药物的疗效及经济性研究综述

目的综述非小细胞肺癌靶向治疗药物的临床疗效及药物经济学评价结果。方法基于非小细胞肺癌的流行病学特征和治疗发展趋势,选取临床应用较多的靶向治疗药物,并检索国内外相关文献,对其治疗非小细胞肺癌的临床疗效和经济性进行综合分析。结果吉非替尼和厄洛替尼是目前针对非小细胞肺癌最受关注的靶向治疗药物。针对不同类型的患者,两者表现出不同的临床疗效,而较少的药物经济学研究显示了其经济性。结论吉非替尼和厄洛替尼的临床疗效和经济性在总体上优于其它治疗方案,但还需更深入的研究。     

Economic burden in patients with ALK + non-small cell lung cancer,with or without brain metastases,receiving second-line anaplastic lymphoma kinase (ALK) inhibitors

Abstract

Aims: To describe the real-world economic burden of patients with anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC) treated with post-crizotinib, second-line ALK inhibitor therapy.

Materials and methods: Retrospective analysis using data from US Optum: Clinformatics Data Mart administrative claims database. Adult patients with ALK?+?NSCLC treated with ceritinib or alectinib as second-line ALK inhibitors between 1 January 2011 and 30 September 2017 were included. Healthcare costs and resource utilization for up to 1?year of therapy were calculated on a per-patient-per-month (PPPM) basis and stratified by presence or absence of brain metastases (BM). Multivariate regression analysis was performed to identify factors associated with costs. Top ten cost drivers of non-inpatient procedure costs were recorded.

Results: One hundred and twelve patients received second-line ALK inhibitors. Total mean PPPM healthcare costs were $23,984 for all patients receiving up to 1?year of post-crizotinib, second-line ALK inhibitor therapy. Total mean PPPM costs for patients with BM on or prior to post-crizotinib, second-line ALK inhibitor therapy were 1.37-times as high as those for patients without BM (p?=?0.0406). Mean PPPM outpatient visits and inpatient hospitalization stays were higher for patients with BM versus no BM. The main cost drivers for non-inpatient procedures were radiation therapy, medications, and diagnostic radiology.

Limitations: Analyses did not include newer ALK-directed therapies. BM development after the index date (defined as the date of the first claim for a second-line ALK inhibitor) may have been misclassified as non-BM. Findings may not be generalizable to patients with no health insurance coverage.

Conclusions: Treatment of patients with ALK?+?NSCLC with ceritinib or alectinib as post-crizotinib, second-line ALK inhibitor therapy represents a high economic burden. Healthcare costs and resource utilization were significantly higher for patients with ALK?+?NSCLC with BM versus no BM.     

Costs of in-house genomic profiling and implications for economic evaluation: a case example of non-small cell lung cancer (NSCLC)

Abstract

Objectives

Genomic profiling in oncology is vital for determining eligible patients for mutation-specific targeted therapies. Use of commercial genomic testing has the potential to improve patient outcomes. Economic evaluations of in-house genomic profiling typically only include material costs while external commercial services include many other factors. Using non-small cell lung cancer (NSCLC) as an example, this study sought to characterize the unique challenges of costing testing services and their impact on results of economic evaluations.     

Use of the Customer Value/Mission (CV/M) Matrix in Strategic Nonprofit Marketing Analysis

ABSTRACT

Application of traditional portfolio methods to nonprofit marketing situations is difficult, to say the least. For the most part, they require detailed market share, market strength, market growth, market attractiveness, and cost and profit accounting information that many nonprofits do not have and may not be able to acquire given the nature of products typically offered by nonprofits, e.g., services and/or social behavior programs. We suggest use of a recently proposed product portfolio model, the customer value/mission (CV/M) matrix as a method that can help nonprofits in then-product planning endeavors. The CV/M matrix better serves the needs of marketing strategists not only in for-profit organizations but in nonprofit ones as well. This is because it reflects on customer value and differential advantage in the eyes of an organization's consumers. This paper directly compares the use of an older portfolio matrix that has been suggested for use in nonprofit organizations with use of the new matrix and discusses some advantages and disadvantages of each.     

The long-run impact of new medical ideas on cancer survival and mortality

ABSTRACT

We test the hypothesis that the arrival of new medical ideas played a major role in the long-run increase in US cancer survival and decline in cancer mortality, by investigating whether the types of cancer (breast, colon, lung, etc.) subject to greater penetration of new ideas, measured using the MEDLINE/PubMED database, had larger subsequent survival gains and mortality reductions, controlling for changing incidence. The 5-year survival rate is strongly positively related to the novelty of ideas in articles published 12–24 years earlier; evidence from case studies that it takes a long time for research evidence to reach clinical practice. Between 1994 and 2008, the 5-year observed survival rate for all cancer sites combined increased from 52.1% to 61.2%. The estimates suggest that about 70% of this increase may have been due to the increase in the novelty of medical ideas 12–24 years earlier. The number of years of potential life lost from cancer before ages 80 and 70 and the number of cancer deaths are inversely related to the novelty of ideas in articles published 12–24 years earlier, conditional on the number of patients diagnosed 1–10 years before and their mean age at time of diagnosis.     

吉非替尼与厄洛替尼治疗非小细胞肺癌效果的间接比较

目的系统评价吉非替尼与厄洛替尼治疗非小细胞肺癌的临床效果.方法检索国内外公开发表的关于吉非替尼或厄洛替尼治疗非小细胞肺癌的中英文文献,采用Bucher法对纳入的研究进行间接比较.结果共纳入4项吉非替尼vs标准治疗和3项厄洛替尼vs标准治疗的文献进行间接比较.吉非替尼与厄洛替尼治疗非小细胞肺癌的反应率和疾病控制率的 RR 值分别为0.56（P=0.0536）、0.87（P=0.6745）,中位生存期和中位无发展生存期的 MD 值分别为-0.31（P=0.7718）、-3.93（P=0.1443）.结论尽管间接比较存在一定的局限性,但结果表明吉非替尼与厄洛替尼治疗非小细胞肺癌的效果无显著性差异.     

MMP-2、TIMP-2与大肠癌浸润转移关系的研究进展

基质金属蛋白酶-2能有效降解Ⅳ、V型胶原及层粘连蛋白,但它的活性却受到组织金属蛋白酶抑制剂-2的影响。研究证实细胞外基质中基质金属蛋白酶及其组织抑制剂的失衡与多种病理机制有关,尤其是肿瘤的浸润与转移密切相关。本文就基质金属蛋白酶及其组织抑制剂的一般特性、在肿瘤发生和发展中的作用进行了综述。     

Public meetings about local cancer clusters: exploring the relative influence of official versus symbolic risk messages on attendees’ post‐meeting concern

Scholars have long lobbied for a view of risk communication that supplants a conventional ‘transmission’ model of risk communication with an alternative that considers the complex social environment that accompanies any risk communication effort. Along these lines, this study examines the relative influence of official health messages versus symbolic risk messages on public meeting attendees’ post‐meeting concern about cancer clusters in six US communities. As part of a larger study of cancer clusters, we obtained written responses from 125 individuals who attended a government‐sponsored public meeting in their community. We asked respondents whether attending the meeting influenced their concerns and, if so, why. The results found that, despite the largely reassuring messages that health officials were giving, most attendees reported feeling more concerned after the meetings in their communities. Regarding why, explanations that denoted symbolic risk messages – unofficial sources of risk information and procedural cues – outnumbered explanations that pointed to official risk messages – scientific presentations – by a score of three to one. The results lend support for a broader view of risk communication, which accounts not only for multiple sources of risk information but also for procedural cues regarding the trustworthiness of an investigation.