Duh Mei Sheng, Reynolds Weiner Jennifer, Lefebvre Patrick, Neary Maureen, Skarin Arthur T
Analysis Group, Inc., Boston, MA 02199, USA.
Curr Med Res Opin. 2008 Apr;24(4):967-74. doi: 10.1185/030079908x280464. Epub 2008 Feb 15.
With new oral chemotherapy drugs emerging, it is useful to understand the costs associated with traditional intravenous (IV) therapy. This study aims to assess costs associated with IV chemotherapy in patients with small cell lung cancer (SCLC) from the perspective of large employer-payers.
Descriptive retrospective claims database analysis.
Using medical claims data from 5.5 million beneficiaries between 01/01/1998 and 01/31/2006, we identified patients with lung cancer (ICD-9 codes 162.3-162.9, 176.4, or 197.0) who received IV chemotherapy. A case-finding SCLC algorithm was then applied which selected patients who were treated with chemotherapies commonly used in SCLC (cisplatin/etoposide, cisplatin/irinotecan, carboplatin/etoposide, topotecan, or cyclophosphamide/doxorubicin/vincristine) and then excluded those who had treatments or procedures indicative of non-small cell lung cancer (NSCLC) (positron emission tomography [PET] scan imaging, lung surgery, common NSCLC chemotherapies). Average total costs paid per day of IV chemotherapy administration were computed, along with separate costs for IV chemotherapy drugs, IV chemotherapy administration procedures, and other drugs and services received on IV visit days. Costs were also estimated per course of treatment based on the assumption of four chemotherapy cycles per course with three visits per cycle.
Among 8010 patients with a lung cancer diagnosis, 802 were identified as SCLC. In the SCLC subset, the average total daily cost was $787 ($9449/course), with $395 ($4742/course; 50.2%) attributable to IV chemotherapy drugs, $93 ($1112/course; 11.8%) to IV chemotherapy administration, and $300 ($3595/course; 38.0%) to other drugs and services.
The proposed algorithm identified about 10% of patients with lung cancer receiving IV chemotherapy as likely SCLC cases. Future studies should validate this algorithm with medical records data. IV chemotherapy administration and other visit-related drugs and services represented about half of the total cost per IV visit day, with the remainder attributable to direct costs for IV chemotherapy drugs.
随着新型口服化疗药物的出现，了解传统静脉注射（IV）疗法的相关成本很有必要。本研究旨在从大型雇主支付方的角度评估小细胞肺癌（SCLC）患者IV化疗的相关成本。
描述性回顾性索赔数据库分析。
利用1998年1月1日至2006年1月31日期间550万受益人的医疗索赔数据，我们确定了接受IV化疗的肺癌患者（ICD - 9编码162.3 - 162.9、176.4或197.0）。然后应用一种病例查找SCLC算法，该算法选择接受SCLC常用化疗（顺铂/依托泊苷、顺铂/伊立替康、卡铂/依托泊苷、拓扑替康或环磷酰胺/阿霉素/长春新碱）治疗的患者，然后排除那些有非小细胞肺癌（NSCLC）治疗或手术指征的患者（正电子发射断层扫描[PET]成像、肺部手术、常见NSCLC化疗）。计算IV化疗给药每天支付的平均总成本，以及IV化疗药物、IV化疗给药程序以及IV就诊日接受其他药物和服务的单独成本。还根据每个疗程四个化疗周期、每个周期三次就诊的假设估算每个疗程的成本。
在8010例肺癌诊断患者中，802例被确定为SCLC。在SCLC亚组中，平均每日总成本为787美元（每个疗程9449美元），其中395美元（每个疗程4742美元；50.2%）归因于IV化疗药物，93美元（每个疗程1112美元；11.8%）归因于IV化疗给药，300美元（每个疗程3595美元；38.0%）归因于其他药物和服务。
所提出的算法确定接受IV化疗的肺癌患者中约10%可能为SCLC病例。未来研究应用病历数据验证该算法。IV化疗给药以及其他就诊相关药物和服务占IV就诊日总成本的约一半，其余归因于IV化疗药物的直接成本。
