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Ginés Rubió J, Delgado O, Callejo A, Domínguez M, Torres C. Healthcare Resource Utilization and Associated Costs among Patients with Advanced Non-Small-Cell Lung Cancer Receiving Chemotherapy or Immunotherapy in Spain: A Single-Center, Real-World, Exploratory Study. Cancers (Basel) 2024; 16:2068. [PMID: 38893187 PMCID: PMC11171292 DOI: 10.3390/cancers16112068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
The objective of this observational, single-center, retrospective study conducted in a Spanish tertiary hospital was to describe the real-world (RW) healthcare resource utilization (HCRU) among patients with advanced non-small-cell lung cancer (aNSCLC) who received chemotherapy (CT) or immunotherapy (IT) as first and second lines of treatment. A total of 173 patients diagnosed with aNSCLC and treated between January 2016 and August 2020 were included. The standardized average costs per patient/year were EUR 40,973.2 and EUR 22,502.4 for first-line CT and IT and EUR 140,601.3 and EUR 20,175.9 for second-line CT and IT, respectively. The average annual costs per patient associated with adverse-event (AE) onset were EUR 29,939.7 and EUR 460.7 for first-line CT and IT and EUR 35,906.4 and EUR 3206.1 for second-line CT and IT, respectively. The costs associated with disease management were EUR 33,178.0 and EUR 22,448.4 for first-line CT and IT and EUR 127,134.2 and EUR 19,663.9 for second-line CT and IT, respectively. In conclusion, IT use showed a lower average annual cost per patient, which was associated with lower HCRU for both disease and AE management, compared to the use of CT. However, these results should be further confirmed in the context of the currently implemented treatment schemes, including the combination of CT with single or dual IT.
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Affiliation(s)
| | - Olga Delgado
- Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Angel Callejo
- OBU Medical Department, AstraZeneca Farmacéutica Spain, 28050 Madrid, Spain; (A.C.); (M.D.); (C.T.)
| | - Marta Domínguez
- OBU Medical Department, AstraZeneca Farmacéutica Spain, 28050 Madrid, Spain; (A.C.); (M.D.); (C.T.)
| | - Covadonga Torres
- OBU Medical Department, AstraZeneca Farmacéutica Spain, 28050 Madrid, Spain; (A.C.); (M.D.); (C.T.)
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Apple J, DerSarkissian M, Shah A, Chang R, Chen Y, He X, Chun J. Economic burden of early-stage non-small-cell lung cancer: an assessment of healthcare resource utilization and medical costs. J Comp Eff Res 2023; 12:e230107. [PMID: 37655686 PMCID: PMC10690396 DOI: 10.57264/cer-2023-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Aim: To quantify the economic burden of early-stage non-small-cell lung cancer (NSCLC) among patients with and without adjuvant therapy. Methods: All-cause and NSCLC-related healthcare resource utilization and medical costs were assessed among patients with resected stage IB-IIIA NSCLC in the SEER-Medicare database (1 January 2011-31 December 2019), from NSCLC diagnosis to death, end of continuous enrollment, or end of data availability (whichever occurred first). Results: Patients receiving adjuvant therapy had the lowest mean NSCLC-related medical costs (adjuvant [n = 1776]: $3738; neoadjuvant [n = 56]: $5793; both [n = 47]: $4818; surgery alone [n = 3478]: $4892, per-person-per-month), driven by lower NSCLC-related hospitalization rates. Conclusion: Post-surgical management of early-stage NSCLC was associated with high economic burden. Adjuvant therapy was associated with numerically lower medical costs over surgical resection alone.
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Affiliation(s)
- Jon Apple
- AstraZeneca Pharmaceuticals, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Maral DerSarkissian
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Anne Shah
- AstraZeneca Pharmaceuticals, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Rose Chang
- Analysis Group, 111 Huntington Avenue, 14th Floor, Boston, MA 02199, USA
| | - Yan Chen
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Xuanhao He
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Justin Chun
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
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Grumberg V, Chouaïd C, Cotté FE, Jouaneton B, Jolivel R, Gaudin AF, Reynaud D, Assié JB, Borget I. Long-term hospital resource utilization and associated costs of care for patients initiating nivolumab in advanced non-small cell lung cancer in France. J Med Econ 2022; 25:691-699. [PMID: 35587018 DOI: 10.1080/13696998.2022.2079291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES In advanced cancers, healthcare resource utilization (HCRU) and costs usually increase until death. However, few studies have measured HCRU over time in patients treated with immunotherapies. The objective was to describe the evolution of HCRU and costs over four years for patients with advanced non-small cell lung cancer (aNSCLC) initiating nivolumab. MATERIALS AND METHODS Based on the French hospital reimbursement database, all aNSCLC patients initiating nivolumab in the 2nd line or later in 2015 or 2016 were followed until 2019. HCRU (including hospitalizations and hospital visits) and costs (payer perspective) were described annually after nivolumab initiation. Trends in HCRU were analyzed with the Mann-Kendall test. As most patients did not reach the four-year follow-up, cost-analysis was performed without adjustment throughout, without adjustment in uncensored cases only or with adjustment using for all patients using the Bang&Tsiatis method. RESULTS 10,452 patients initiating nivolumab were evaluated. The percentage of patients hospitalized or with hospital visits decreased (p < .001) over the four-year follow-up with the exception of consultations. The number of hospital visits per patient decreased from 23.3 in Y1 to 13.2 in Y4 without adjustment and 18.3 with adjustment (p < .001). The overall hospitalization duration per patient (days) decreased from 36.0 (Y1) to 14.9 (Y4-unadjusted) and 20.5 (Y4-adjusted) (p < .001). Annual per capita costs also decreased. The method without adjustment provided the lowest cost over time (€44,404 (Y1), €32,206 (Y2); €28,552 (Y3); €18,841(Y4)) while the Bang&Tsiatis method presented the highest cost (€45,002 (Y1), €36,330 (Y2); €35,080 (Y3); €28,931 (Y4)). CONCLUSION HCRU and costs for NSCLC patients treated with nivolumab decreased over time. Cost estimates are dependent on the statistical method used to take into account uncertainty, but costs decreased over time whatever the method used.
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Affiliation(s)
- Valentine Grumberg
- Bristol Myers Squibb France, Rueil-Malmaison, France
- Oncostat, CESP, INSERM U1018, Paris-Saclay University, "Ligue Contre le Cancer" labeled team, Villejuif, France
| | - Christos Chouaïd
- Department of Chest Medicine, Créteil University Hospital, Créteil, France
- INSERM U955, UPEC, IMRB, Créteil, France
| | | | | | | | | | | | - Jean-Baptiste Assié
- Department of Chest Medicine, Créteil University Hospital, Créteil, France
- INSERM U1138 Centre de Recherche des Cordeliers (CRC), Paris, France
| | - Isabelle Borget
- Oncostat, CESP, INSERM U1018, Paris-Saclay University, "Ligue Contre le Cancer" labeled team, Villejuif, France
- Biostatistics and Epidemiology Office, Direction of Clinical Research, Gustave Roussy, Paris-Saclay University, Villejuif, France
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Nieder C, Imingen KS, Haukland E. Palliative Thoracic Radiotherapy for Non-Small Cell Lung Cancer in Outpatients: Reasons for Unplanned Hospitalization and Its Impact on Survival. J Clin Med Res 2021; 13:177-183. [PMID: 33854658 PMCID: PMC8016527 DOI: 10.14740/jocmr4445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background The aims of the study were to examine the rates of and reasons for unplanned hospitalization after start of palliative radiotherapy or chemoradiation (CRT), and to study whether unplanned hospitalization deteriorates patients’ prognosis. In addition, risk factors were identified. Methods A retrospective review of 136 patients treated with palliative radiotherapy or CRT was performed. Inclusion criteria were prescribed total dose at least 30 Gy and outpatient at the start of treatment. Uni- and multivariate analyses were employed. Results Fifty-eight patients (43%) were hospitalized within 3 months from start of radiotherapy or CRT. Their median overall survival was 6.7 months as compared to 11.1 months in non-hospitalized patients (P = 0.09). The median length of hospitalization was 8 days (range 1 - 61). In patients with possibly treatment-related hospitalization (n = 32), median survival was 5.0 months, significantly shorter than the 11.1 months observed in the remaining patients (P = 0.006). In multivariate analysis, only one variable was significantly associated with higher risk of unplanned hospitalization: previous hospitalization in the last 4 weeks before commencing radiotherapy or CRT. Conclusions Unplanned hospitalization occurred frequently in a standard care setting without early involvement of a dedicated palliative team. Patients with preceding hospitalization might represent a group that is particularly vulnerable, thus qualifying for a targeted intervention aiming at continued outpatient care.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodo, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, 9037 Tromso, Norway
| | - Kristian S Imingen
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodo, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, 9037 Tromso, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodo, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, 9037 Tromso, Norway.,SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, 4036 Stavanger, Norway
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Soares M, Antunes L, Redondo P, Borges M, Hermans R, Patel D, Grimson F, Munro R, Chaib C, Lacoin L, Daumont M, Penrod JR, O'Donnell JC, Bento MJ, Gonçalves FR. Treatment and outcomes for early non-small-cell lung cancer: a retrospective analysis of a Portuguese hospital database. Lung Cancer Manag 2021; 10:LMT46. [PMID: 34084212 PMCID: PMC8162184 DOI: 10.2217/lmt-2020-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: This observational study evaluated treatment patterns and survival for patients with stage I–IIIA non-small-cell lung cancer (NSCLC). Materials & methods: Adults newly diagnosed with NSCLC in 2012–2016 at IPO-Porto hospital were included. Treatment data were available for patients diagnosed in 2015–2016. Results: 495 patients were included (median age: 67 years). The most common treatments were surgery alone or with another therapy (stage I: 66%) and systemic anticancer therapy plus radiotherapy (stage II: 54%; stage IIIA: 59%). One-year OS (95% CI) for patients with stage I, II and IIIA NSCLC (diagnosed 2012–2016) were 92% (88–96), 71% (62–82) and 69% (63–75), respectively; one-year OS (95% CI) for treated patients with stage I–II or stage IIIA NSCLC (diagnosed 2015–2016) were 89% (81–97) and 86% (75–98) for non-squamous cell and 76% (60–95) and 49% (34–70) for squamous cell NSCLC. Conclusion: Treatment advances are strongly needed for stage I–IIIA NSCLC, especially for patients with squamous cell histology.
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Affiliation(s)
- Marta Soares
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal
| | - Luís Antunes
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal
| | - Patrícia Redondo
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal
| | - Marina Borges
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal
| | | | - Dony Patel
- Real World Solutions, IQVIA, London, N1 9JY, UK
| | | | - Robin Munro
- Real World Solutions, IQVIA, London, N1 9JY, UK
| | - Carlos Chaib
- R&D Medical Affairs, Bristol Myers Squibb, 28050 Madrid, Spain
| | - Laure Lacoin
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, 1420 Braine-l'Alleud, Belgium.,Epi-Fit, Bordeaux, Nouvelle-Aquitaine 33000, France
| | - Melinda Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, 1420 Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ 08540, USA
| | - John C O'Donnell
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ 08540, USA
| | - Maria José Bento
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal.,Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
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Lee DH, Isobe H, Wirtz H, Aleixo SB, Parente P, de Marinis F, Huang M, Arunachalam A, Kothari S, Cao X, Donnini N, Woodgate AM, de Castro J. Health care resource use among patients with advanced non-small cell lung cancer: the PIvOTAL retrospective observational study. BMC Health Serv Res 2018; 18:147. [PMID: 29490654 PMCID: PMC5831211 DOI: 10.1186/s12913-018-2946-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 02/19/2018] [Indexed: 01/10/2023] Open
Abstract
Background Data are scarce regarding real-world health care resource use (HCRU) for non-small cell lung cancer (NSCLC). An understanding of current clinical practices and HCRU is needed to provide a benchmark for rapidly evolving NSCLC management recommendations and therapeutic options. The objective of this study was to describe real-world HCRU for patients with advanced NSCLC. Methods This multinational, retrospective chart review study was conducted at academic and community oncology sites in Italy, Spain, Germany, Australia, Japan, South Korea, Taiwan, and Brazil. Deidentified data were drawn from medical records of 1440 adults (≥18 years old) who initiated systemic therapy (2011 to mid-2013) for a new, confirmed diagnosis of advanced or metastatic (stage IIIB or IV) NSCLC. We summarized HCRU associated with first and subsequent lines of systemic therapy for advanced/metastatic NSCLC. Results The proportion of patients who were hospitalized at least once varied by country from 24% in Italy to 81% in Japan during first-line therapy and from 22% in Italy to 84% in Japan during second-line therapy; overall hospitalization frequency was 2.5–11.1 per 100 patient-weeks, depending on country. Emergency visit frequency also varied among countries (overall from 0.3–5.9 per 100 patient-weeks), increasing consistently from first- through third-line therapy in each country. The outpatient setting was the most common setting of resource use. Most patients in the study had multiple outpatient visits in association with each line of therapy (overall from 21.1 to 59.0 outpatient visits per 100 patient-weeks, depending on country). The use of health care resources showed no regular pattern associated with results of tests for activating mutations of the epidermal growth factor receptor (EGFR) gene or anaplastic lymphoma kinase (ALK) gene rearrangements. Conclusions HCRU varied across countries. These findings suggest differing approaches to the clinical management of advanced NSCLC among the eight countries. Comparative findings and an understanding of country-specific clinical practices can help to identify areas of need and guide future resource allocation for patients with advanced NSCLC. Further studies evaluating the costs associated with resource use are warranted. Electronic supplementary material The online version of this article (10.1186/s12913-018-2946-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dae Ho Lee
- Asan Medical Center, Seoul, Republic of Korea
| | | | | | | | - Phillip Parente
- Cancer Services, Box Hill Hospital, and Monash University, Victoria, Australia
| | - Filippo de Marinis
- Thoracic Oncology Division, European Institute of Oncology (IEO), Milan, Italy
| | - Min Huang
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., North Wales, PA, USA
| | - Ashwini Arunachalam
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
| | - Smita Kothari
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Xiting Cao
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | | | | | - Javier de Castro
- Medical Oncology Service, Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
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Girard N, Corral J, Cortinovis D, Heigener DF. Second-Line Treatment Selection in Patients With Non-Small-Cell Lung Cancer of Adenocarcinoma Histology: Findings From a European Survey of Treating Physicians. Clin Lung Cancer 2016; 18:e89-e97. [PMID: 27865625 DOI: 10.1016/j.cllc.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Guidelines provide treatment recommendations for advanced non-small-cell lung cancer (NSCLC), but physicians must also consider other factors. We surveyed physicians treating NSCLC to determine their therapy goals, drivers of treatment choice, current prescribing behavior, and therapy expectations. MATERIALS AND METHODS In 2015, an online survey was conducted of 500 pulmonologists/oncologists treating lung adenocarcinoma in Germany, France, Italy, Spain, and the United Kingdom, comprising screening and therapy decision questions. RESULTS On average, physicians had 14.7 years of experience and treated 79 patients/3 months with stage IIIb/IV NSCLC. In patients with Eastern Cooperative Oncology Group (ECOG) 0-1, "prolonged survival/extending life" was the main therapy goal of physicians for first- (63%) and second-line (40%) patients; improvement in quality of life (QoL) was the main goal of 14% of physicians for second-line patients. For patients with ECOG ≥2, the main goal of second-line therapy was improvement in QoL (26%) or tumor-related symptoms (23%). Most (57%) physicians strongly agreed that they preferred a second-line treatment that extends overall survival (OS) while maintaining QoL; their greatest dissatisfaction with available second-line treatment options was the inability to "stop tumor progression over the long term" (66%). Physicians expected new therapies to become available within 12 months that would provide improvements in progression-free survival (83%) or OS (69%). CONCLUSION OS is important for second-line treatments in patients with stage IIIb/IV NSCLC, although QoL improvements should not be underestimated. This survey highlights the wait faced by patients and physicians as treatments transition from clinical trials to clinical practice.
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Affiliation(s)
- Nicolas Girard
- Department of Respiratory Medicine, Institute of Oncology of the Hospices Civils de Lyon, Lyon, France.
| | - Jesus Corral
- Department of Medical Oncology, Virgen del Rocio University Hospital, Seville, Spain
| | | | - David F Heigener
- Thoracic Oncology, Lungen Clinic Grosshansdorf, Member of the German Center for Lung Research, Grosshansdorf, Germany
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