Delea Thomas, Langer Corey, McKiernan James, Liss Martin, Edelsberg John, Brandman Jane, Sung Jennifer, Raut Monika, Oster Gerry
Policy Analysis Inc. (PAI), Brookline, Mass., USA.
Oncology. 2004;67(5-6):390-6. doi: 10.1159/000082923.
Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) including pathological fracture, spinal cord compression, hypercalcemia or pain requiring surgery, radiotherapy or opioid analgesics. These complications result in impaired mobility and reduced quality of life and have a significant negative impact on survival. The economic consequences of SREs in patients with lung cancer have not been examined.
We conducted a retrospective analysis using a large US health insurance claims database to estimate the incidence and costs of treatment of SREs in patients with bone metastases of lung cancer treated in a naturalistic setting. Study subjects had >/=2 encounters with a diagnosis of primary lung cancer and >/=2 encounters with a diagnosis of metastases to bone. SREs were identified based on the occurrence on or after the date of first diagnosis of bone metastases, of (1) >/=1 encounter with a diagnosis of pathological fracture, spinal cord compression or hypercalcemia, (2) >/=1 bone surgery or radiotherapy procedure, or (3) the initiation of opioid analgesic therapy. Survival and costs of SRE-related care in patients with SREs were estimated using Kaplan-Meier methods.
We identified 534 patients with lung cancer and bone metastases, including 295 (55%) with >/=1 SRE. Radiotherapy (68%) and fracture (35%) were the most common SREs. Median survival after the first identified SRE was 4.1 months (95% confidence interval: 3.6-5.5 months). The estimated lifetime SRE-related cost per patient was USD 11,979 (95% confidence interval: USD 10,193-13,766). Radiotherapy accounted for the greatest proportion of cost (61%) by SRE type.
The economic burden of SREs in patients with bone metastases of lung cancer is substantial. Intravenous bisphosphonates, such as zoledronic acid, which have been shown to prevent these events, may reduce these costs.
肺癌骨转移患者常发生骨相关事件（SREs），包括病理性骨折、脊髓压迫、高钙血症或需要手术、放疗或阿片类镇痛药治疗的疼痛。这些并发症导致活动能力受损和生活质量下降，并对生存产生重大负面影响。尚未对肺癌患者发生SREs的经济后果进行研究。
我们使用一个大型美国医疗保险索赔数据库进行了一项回顾性分析，以估计在自然环境中接受治疗的肺癌骨转移患者发生SREs的发生率和治疗费用。研究对象有≥2次诊断为原发性肺癌的就诊记录，以及≥2次诊断为骨转移的就诊记录。根据首次诊断骨转移日期及之后发生的以下情况确定SREs：（1）≥1次诊断为病理性骨折、脊髓压迫或高钙血症的就诊记录；（2）≥1次骨手术或放疗程序；或（3）开始使用阿片类镇痛治疗。使用Kaplan-Meier方法估计发生SREs患者的生存情况和SRE相关护理的费用。
我们确定了534例肺癌骨转移患者，其中295例（55%）发生≥1次SREs。放疗（68%）和骨折（35%）是最常见的SREs。首次确定SREs后的中位生存期为4.1个月（95%置信区间：3.6 - 5.5个月）。估计每位患者与SREs相关的终生费用为11,979美元（95%置信区间：10,193 - 13,766美元）。按SRE类型划分，放疗占费用的最大比例（61%）。
肺癌骨转移患者发生SREs的经济负担巨大。已证明能预防这些事件的静脉用双膦酸盐类药物，如唑来膦酸，可能会降低这些费用。
