Real-world healthcare resource utilization in a European non-small cell lung cancer population: the EPICLIN-Lung study

BACKGROUND

There is a lack of data on health resource assessment in non-small cell lung cancer (NSCLC) to inform clinical decision-making. The Epidemiological Study to Describe NSCLC Clinical Management Pattern in Europe-Lung (EPICLIN-Lung) study provides information on healthcare resource utilization associated with different NSCLC treatment strategies in real-life clinical settings.

METHODS

This multinational, multicenter, non-interventional study (NCT00831909) was conducted in eight European countries in 2009-2010. Patients with confirmed NSCLC were enrolled and followed for 12 months or until death. Information was collected on patient and disease characteristics, diagnosis and treatment patterns. Healthcare resource utilization was described in relation to diagnostic patterns and treatment received.

RESULTS

Data were available for 3508 patients (median age=65.0 years, male=77.6%, Caucasian=98.4%, adenocarcinoma=43.8%, stage IV=48.6%, 10.8% never smoked). The overall mean number of hospitalization days was 16.4 (standard deviation (SD)=18.42). Patients were followed up for a mean of 245.8 (131.4) days. Most patients (96.0%) underwent imaging procedures, most commonly scanning (93.9%). Surgery was associated with a mean of 12.5 (9.33) hospitalization days, with lobectomy and extended procedures (20.3%) being the most common surgery types. Radiotherapy resulted in a mean of 11.6 (14.12) hospitalization days. The majority of radiotherapy was palliative (56.0%), which resulted in fewer (mean 9.5 [11.12]) hospitalization days. Administration of systemic treatment resulted in a mean of 6.5 (8.04) hospitalization days, 1.7 (3.59) visits for disease-related events, 2.3 (1.83) adverse events and 5.4 (5.86) blood-specific resources. The key limitations of this study are those inherent to its non-interventional nature and wide regional focus, and the lack of cost-effectiveness data.

CONCLUSIONS

EPICLIN-Lung provides important, Europe-wide information on drivers of healthcare resource use in different treatment strategies for NSCLC.

Clinical management patterns and treatment outcomes in patients with non-small cell lung cancer (NSCLC) across Europe: EPICLIN-Lung study

BACKGROUND

Throughout Europe, physicians face similar challenges in non-small cell lung cancer (NSCLC) management, but comprehensive international information on usual clinical practice is lacking so the burden of NSCLC is not fully understood.

METHODS

This multinational, multicentre, non-interventional study (NCT00831909) was conducted in eight European countries. Patients with confirmed NSCLC were consecutively enrolled from January to March 2009 and followed for 12 months or until death. Information was collected on patient and disease characteristics, diagnosis and treatment patterns, and clinical outcomes. Spontaneously reported adverse events (AEs) were also recorded.

RESULTS

Data were available for 3508 patients. Most patients (77.5%) were male, median (range) age was 65.0 years (21.6-90.7), the majority of patients had a World Health Organization performance status of ≤1 (74.7%), and 10.8% were never smokers. The most prevalent histologies were adenocarcinoma (43.8%) and squamous-cell carcinoma (29.4%). Most patients presented with advanced disease (11.6% with stage IIIA, 18.7% with stage IIIB, 48.6% with stage IV). In stage IV disease, median progression-free survival and overall survival (months) by first-line treatment cluster were platinum regimens: 6.5, 10.8; non-platinum regimens: 4.3, 8.5; regimens with bevacizumab 8.7, 12.9; investigational regimens: 5.6, 10.8; best supportive care: 5.4, 6.6. The most frequently reported severe (Common Terminology Criteria for Adverse Events v3.0>2) AEs were blood/bone marrow (16.0%) and pulmonary/upper respiratory (7.8%). Key limitations of this study related to its non-interventional nature and wide regional focus; for example, achieving a representative sample of the overall NSCLC population, variation in recruitment between countries, and data based on information from medical records derived from routine visits.

CONCLUSIONS

The Epidemiological Study to Describe NSCLC Clinical Management Pattern in Europe-Lung (EPICLIN-Lung) study provides new insights into the descriptive patterns and clinical management strategies for NSCLC across Europe, and how they affect patient outcomes.

Update on the treatment of non-small-cell lung cancer: focus on the cost-effectiveness of new agents

Background

The incidence of lung cancer and the cost of drug treatment have increased dramatically in the last decade. This article examines the costs of new target agents, such as tyrosine kinase inhibitors (TKIs) and anti-angiogenic drugs.

Methods

This study uses PubMed research to focus on the topics of lung cancer, economics, and new targeted therapies.

Results

The published papers only addressed TKIs and anti-angiogenic antibodies. For gefitinib, the results favored a clinical-based selection, despite the low number of studies. Erlotinib was studied in second line and as a maintenance treatment (with the studies reaching opposite conclusions in terms of cost-effectiveness). Economic analyses were not in favor of bevacizumab, but the studies on this topic were very heterogeneous.

Conclusion

The economic impact of a drug depends on the health care system organization. Future clinical trials must include economic analyses, particularly with TKIs in the first line.

Multicenter observational study of erlotinib therapy (OBSTAR) for non small-cell lung cancer: a GFPC study

CONTEXT

Erlotinib therapy for non small-cell lung cancer (NSCLC) has mainly been evaluated in randomized trials.

METHOD

OBSTAR was a multicenter, retrospective, observational study involving all patients treated with erlotinib in 18 French centers between June 2005 and September 2007. The analyses focused on the patients' characteristics, previous treatments, and treatment efficacy during a three-year follow-up period.

RESULTS

534 patients were included in this study. The median survival times were respectively 5.2 [3.7-7.4] and 4.7 [4.1-5.7] months, depending to whether erlotinib was used as second- (n=190), or ≥ third-line treatment (n=305). The disease control rate were 39.1% [30.2-48.7] and 29.9% [29.6-36.9] according to the line of treatment. Factors predictive of an objective response were gender, age, and smoking status. Factors predictive of progression were age, sex, smoking status, the line of treatment, and the number of metastases. Treatment had to be interrupted for toxicity in 8.5% of cases.

CONCLUSION

This study of erlotinib therapy in 2005-2007 confirms, in the general NSCLC patient population, the results of pivotal trials.

Randomized follow-up study of resected NSCLC patients: conventional versus 18F-DG coincidence imaging

The aim of this study was to compare the utility of gamma camera using a coincidence detection system imaging (CDET) with 18-fluorodeoxyglucose to conventional imaging techniques in the detection of recurrence of non-small cell lung cancer. Sixty-nine patients were randomized into two groups for follow-up after surgery from October 2000 to December 2002. Each patient was evaluated every 6 months by conventional technique imaging in group A (n=33) or CDET imaging in group B (n=36) over two years. The direct costs of each procedure were evaluated. The major endpoint was the number of recurrences or new tumours detected. The two groups were similar. A total of 25 recurrences was detected (9 in group A and 16 in group B). Overall survival was similar in the two groups. CDET imaging was more expensive. CDET imaging provides earlier detection of recurrence, but does not modify survival outcome. Further studies are necessary to demonstrate the impact, if any, of 18-FDG imaging.

Analysis of the costs of bevacizumab plus cisplatin and gemcitabine versus cetuximab plus vinorelbine and cisplatin in patients with advanced non-small cell lung cancer (NSCLC) in France: Results from a cost modelling study

e17560

Background: New treatment options for advanced NSCLC can offer improved survival over standard chemotherapy (CT). Bevacizumab (BEV), a humanized monoclonal antibody (MAb) directed against VEGF when combined with CT increases overall survival (median 13.6 months in the AVAiL study) and progression-free survival (PFS) in patients with advanced NSCLC compared with CT alone. Cetuximab (CTX), an IgG1 MAb which targets the epidermal growth factor receptor, achieved a median survival of 11.3 months when combined with CT in the FLEX study; marketing authorization is anticipated during 2009. The aim of this study was to compare the costs of treating patients with BEV plus cisplatin and gemcitabine (BCG) versus CTX plus vinorelbine and cisplatin (CVC) in France. Methods: A Markov model was used to compare drug and administration costs associated with treating advanced NSCLC with either BCG or CVC. The model assumes patients move from non-progressive to progressed disease to death, according to transition probabilities derived from an indirect comparison of the efficacy of BCG and CVC in terms of PFS using data from the respective pivotal trials and appropriate indirect comparison methodology. Cost data were derived from local sources. Drug costs assumed CT was given for up to 6 cycles, that CTX was administered at an initial dose of 400 mg/m2 followed by 250 mg/m2 weekly until progression and that BEV was administered at 7.5 mg/kg every 3 weeks until progression. The model estimated average drug and administration costs per patient treated with either BCG or CVC. Results: The mean cost for BCG and CVC was €23849 and €35678 respectively, resulting in a saving of €11829 per patient for BCG. The acquisition of BEV was less costly than the acquisition of CTX (€15374 vs €23530) and, BCG acquisition and administration costs were lower than CTX's respectively, €19756 versus €24750 and €4093 versus €10928. Conclusions: Targeted therapy using BEV is less costly than CTX in France, and therefore, from a budget perspective offers the best value for money approach to improving outcomes in patients with advanced NSCLC.

[Table: see text]

[Stage IV NSCLC. Economic analysis in lung cancers]

OBJECTIVE

To explain the help of economic analyses in the understanding of lung cancer (LC) management with a description of the quality of selected papers.

METHODS

In the first part, quality criteria of economic analyses are depicted with the key words for the literature selection.

RESULTS

The global costs of LC through literature review are depicted; then, in a second part, the costs of each stage of the disease. Finally, costs of chemotherapeutic drugs and target molecules are also discussed.

CONCLUSION

Economic analyses are unavoidable to assess the burden of the disease but also the cost of each management strategy for LC.

[Inhaled corticosteroids in asthma: a medico-economic analysis of clinical trials]

BACKGROUND

Asthma is a chronic disease with a heavy economic burden in terms of public health on account of its clinical impact and consequences on quality of life and costs. Its management is based on pharmacological measures with inhaled corticosteroids playing a large role. The objective of this study was to undertake an analysis of the published literature of medico-economic trials of the use of inhaled corticosteroids.

METHODS

A review of the literature from 1990 to 2007 was undertaken with separate analyses of studies of inhaled steroids alone and those looking at combined preparations.

RESULTS

The costs of asthma vary greatly depending on the clinical management. Analysis of the published clinical trials showed that the addition of inhaled steroids increased the total cost. When efficacy is taken into account the economic results are acceptable for developed societies. The use of inhaled steroids as maintenance therapy, or maintenance and symptomatic therapy, was always cost effective.

CONCLUSION

These results are based on data from clinical trials. They need to be confirmed by large scale observational studies using validated criteria of effectiveness.

[How to treat the relapse of NSCLC after surgery and chemotherapy? IFTC 0702 randomized phase III study]

BACKGROUND

As chemotherapy gains wider acceptance for the treatment of earlier stages of NSCLC, particularly in the adjuvant and neoadjuvant setting, physicians face a growing population of high performance status patients who have relapsed after their first-line chemotherapy. The type of second-line chemotherapy after initial adjuvant or neoadjuvant treatment with a platinum-based regimen remains largely undefined. The current study has been designed to compare the classical mono chemotherapy docetaxel with a docetaxel cisplatin doublet.

METHODS

Patients will be randomized in 2 arms. Arm: docetaxel cisplatin (cycles repeated every 21 days), 4 cycles followed by 2 cycles of docetaxel alone in case of objective response or stabilisation. Arm B: docetaxel alone (cycles repeated every 21 days), 4 cycles followed by 2 cycles of docetaxel alone in case of objective response or stabilisation.

EXPECTED RESULTS

300 patients will be randomized with a statistical hypothesis of a progression free survival of 3 months in the control arm and of 4.5 months in the experimental arm.

Impact of chronic airflow obstruction in a working population

Data on the individual and collective impact of chronic airflow obstruction at a population level are scarce. In a nationwide survey, dyspnoea, quality of life and missed working days were compared between subjects with and without spirometrically diagnosed chronic airflow obstruction. Subjects aged > or =45 yrs were recruited in French health prevention centres (n = 5,008). Results of pre-bronchodilator spirometry and questionnaires (European Community Respiratory Health Survey-derived questionnaire and European quality of life five-dimension questionnaire) were collected. Adequate datasets were available for 4,764 subjects aged 60+/-10 yrs (only 2% were aged > or =80 yrs). The prevalence of airflow obstruction (forced expiratory volume in one second/forced vital capacity of <0.70) was 7.5%. The vast majority (93.9%) of cases had not been diagnosed previously. Health status was significantly influenced by dyspnoea. Both were associated with the number of missed working days. Despite mild-to-moderate severity, subjects with chronic airflow obstruction exhibited more dyspnoea, poorer quality of life and higher numbers of missed working days (mean 6.71 versus 1.45 days.patient(-1).yr(-1) in patients without airflow obstruction, for the population with no known heart or lung disease). In conclusion, even mild-to-moderate airflow obstruction is associated with an impaired health status, which represents an additional argument in favour of early detection in chronic obstructive pulmonary disease.

[The payer, the T2A pathway, the physician, the patient: the exemple of thoracic oncology]

BACKGROUND

For a few years, the French health system has implemented a lot of reforms which have consequences on patients' management, particularly in oncology.

METHODS

The main legislative texts are described. There were published after 2002-2007 hospital plan. These texts are analyzed according to several perspectives.

RESULTS

The implementation of the new fee scale (T2A: Tarification à l'Activité) is done according to the point of view of the payer with its economic basis. The T2A associates financing bound in relation to activity and other financed in supplement. The physicians'perspective can be in the opposite of the point of view of the payer, because they have to modify some management strategies. The patient's point of view can be dramatically opposite. A description of the ideal patient within the T2A pathway is secondary performed.

CONCLUSION

Each economical logic (the patients, the payer and the physicians) can be in opposition. Ethic has to be predominant and indicators, like practice guidelines and evaluation, have to balance economical considerations.

[Stage IV non-small cell lung cancer. Duration of chemotherapy for locally advanced non small cell lung cancers]

BACKGROUND

Optimal duration of first line chemotherapy for non surgical non small cell lung cancer (NSCLC) is still debated. It concerns the length of initial chemotherapy and the use of maintenance treatments.

METHODS

Literature review was performed on maintenance and duration of chemotherapy.

RESULTS

The use of maintenance chemotherapy showed no differences in terms of survival. One study (with gemcitabine as maintenance treatment) found a difference in terms of time to progression. Several randomized clinical trials were carried out on duration of chemotherapy. There were no impact on survival time.

CONCLUSION

No positive results were found with an increase of chemotherapeutic cycles. Maintenance therapy needs more additive studies. ASCO guidelines may be currently used.

Analyse économique de l’administration d’une chimiothérapie en hospitalisation à domicile (HAD) comparée à l’hospitalisation de jour dans les cancers bronchopulmonaires non à petites cellules de stade IV

BACKGROUND

French law and government decisions have induced new development for home base treatments. The objective was to compare cost of home base chemotherapy (HBC) versus outpatient infusions, for non small cell lung cancer (NSCLC).

METHODS

10 patients were selected in each category. D8 of their cycles was performed at home compared to outpatient infusion. Costs were based on national fees with cytostatic drugs as supplement. The real cost was also assessed through a specific questionnaire.

RESULTS

30 D8 infusions were carried out at hospital and 24 D8 infusions at home. Average cost by cycle was 2,829.51 euros [2 560.74-3 147.02] for hospital infusion, 2,372.50 euros [1 962.75-2 792.88] for HBC (-16.15%). Difference was -457.01 euros by cycle [-919.74; 26.82]. Real costs by injection for BHC was 484.42 euros [424.18; 540.32] versus a fee of 699.89 euros [643.64; 750.23]. There were no difference in terms of adverse events.

CONCLUSION

HBC for NSCLC is feasible. Average costs by cycle is lower of 16% versus hospital infusion. The results of this non randomized study had to be confirm by further clinical trials.

[Tools for assessing healthcare delivery]

INTRODUCTION

Assessing the quality of care has become an essential part of the medical process. In France, the Professional Practice Evaluation requires a sound knowledge of these techniques.

BACKGROUND

The different tools that can be used to carry out quality assessment are presented, with their specific applications. Two main categories can be used. The first are information synthesis techniques such as consensus conferences, practice guidelines, and panellist's appropriateness rating. The second category is based on comparison to a reference: clinical audit, targeted clinical audit, or appropriateness evaluation protocols. Other, less commonly employed approaches include a problem solving approach, which is often included in total quality management, clinical care pathway, risk management, mortality morbidity conference, adverse event monitoring, and statistical process control charts.

VIEWPOINT

These tools will be widely used in the next few years, because the recent changes in French law could increase their use.

CONCLUSION

A good knowledge of these techniques is needed in order to improve quality assessment.

Docetaxel and concurrent radiotherapy after two cycles of induction chemotherapy with cisplatin and vinorelbine in patients with locally advanced non-small-cell lung cancer. A phase II trial conducted by the Groupe Francais de Pneumo-Cancerologie (GFPC)

CONTEXT

The most satisfactory treatment for patients with locally advanced non-small-cell lung cancer (NSCLC) is combination chemotherapy-radiotherapy (CT-RT). The optimal treatment modalities remain to be determined.

OBJECTIVE

We conducted a multicenter phase II trial of the docetaxel-radiotherapy combination after induction chemotherapy with cisplatin-vinorelbine. The main endpoint was the objective response rate.

PATIENTS AND METHODS

Patient with inoperable stage locally advanced NSCLC received induction chemotherapy consisting of two cycles of cisplatin 100 mg/m2 on D1 and vinorelbine 25 mg/m2 on D1, D8, D15 and D22. Patients with responses or stable disease then received concurrent RT-CT consisting of 25 mg/m2/week docetaxel and single-fraction radiotherapy (66 grays (Gy) in 33 fractions) over 6.5 weeks.

RESULTS

Fifty-six patients were enrolled from 1 July 2000 to 31 December 2001. Sixteen patients left the trial after induction chemotherapy, eight for progression, five for toxicity, and two for intercurrent events. One patient underwent surgery after induction chemotherapy. In total, 40 of the 56 patients received RT-CT. Twelve (30%) of these 40 patients experienced grade III or IV pulmonary or esophageal toxicity. In the intention-to-treat analysis, the objective response rate was 46.4% (95% CI 33.0-60.2). The median time to progression was 6.2 months [1.1-26.0]. The median survival time was 13 months [0.3-44.9 months]. Nine patients progressed during RT-CT, six with brain metastases.

CONCLUSION

Weekly docetaxel with concurrent radiotherapy, following chemotherapy is acceptable. The tumor response rate is moderate. Further trials are required to determine the risk-benefit relationship of this treatment schedule, and the possible benefit of adding other cytotoxic drugs.