Analysis Group, Inc, Boston, MA 02199, USA.
J Med Econ. 2011;14(5):542-52. doi: 10.3111/13696998.2011.596600. Epub 2011 Jul 6.
To compare the health care costs of patients with metastatic colorectal cancer (mCRC) who received second-line treatment with Avastin (bevacizumab) versus Erbitux (cetuximab), from the third-party payer's perspective.
Patients with mCRC were selected from the PharMetrics claims database if they received second-line therapy containing either bevacizumab (second-line bevacizumab cohort) or cetuximab (second-line cetuximab cohort). Six-month costs following second-line therapy start date and average monthly healthcare costs while on second-line therapy (in 2009 US$) were calculated and compared between the two groups.
A total of 2188 patients with mCRC who met the eligibility criteria were included in the analysis, including 1808 patients receiving bevacizumab and 380 patients receiving cetuximab in second-line treatment. Demographic and baseline characteristics were similar between the two groups. Patients' mean age was 61 years and 56% were males. In second-line treatment, bevacizumab was commonly used with oxaliplatin (43.5%) and irinotecan-based regimens (40.4%), whereas cetuximab was commonly used with irinotecan-based regimens (68.2%). Bevacizumab patients had significantly lower total all-cause healthcare costs than cetuximab patients (adjusted difference: -$10,231, p = 0.020), and lower medical costs (-$10,796, p = 0.012) during the 6 months following second-line therapy initiation. Approximately half of the difference in total all-cause healthcare costs was attributable to the lower chemotherapy and targeted therapy costs (-$5635, p = 0.032) of bevacizumab patients than those of cetuximab patients. While on second-line therapy, bevacizumab patients also had lower average monthly all-cause healthcare costs than cetuximab patients.
Second-line treatment in the current study was defined based on changes in mCRC medications, not based on disease progression due to the limited clinical information available in claims.
The use of bevacizumab in second-line therapy was associated with significantly lower healthcare costs in mCRC patients, compared to the use of cetuximab.
从第三方支付者的角度比较转移性结直肠癌（mCRC）患者二线接受阿瓦斯汀（贝伐珠单抗）与爱必妥（西妥昔单抗）治疗的医疗成本。
从 PharMetrics 理赔数据库中选择 mCRC 患者，如果他们接受二线治疗，包含贝伐珠单抗（二线贝伐珠单抗队列）或西妥昔单抗（二线西妥昔单抗队列）。计算二线治疗开始后 6 个月的成本和二线治疗期间（2009 年的美元）的平均每月医疗保健成本，并在两组之间进行比较。
共有 2188 名符合资格标准的 mCRC 患者纳入分析，其中 1808 名患者接受贝伐珠单抗二线治疗，380 名患者接受西妥昔单抗二线治疗。两组患者的人口统计学和基线特征相似。患者的平均年龄为 61 岁，56%为男性。在二线治疗中，贝伐珠单抗与奥沙利铂（43.5%）和伊立替康为基础的方案（40.4%）联合使用，而西妥昔单抗与伊立替康为基础的方案（68.2%）联合使用。与西妥昔单抗组患者相比，贝伐珠单抗组患者的总全因医疗保健费用显著降低（调整差异：-10231 美元，p=0.020），二线治疗开始后 6 个月的医疗费用也较低（-10796 美元，p=0.012）。总全因医疗保健费用差异的约一半归因于贝伐珠单抗组患者的化疗和靶向治疗费用低于西妥昔单抗组患者（-5635 美元，p=0.032）。在接受二线治疗期间，贝伐珠单抗组患者的平均每月全因医疗保健费用也低于西妥昔单抗组患者。
本研究中的二线治疗是根据转移性结直肠癌药物的变化来定义的，而不是根据索赔中可用的有限临床信息来定义疾病进展。
与使用西妥昔单抗相比，二线治疗中使用贝伐珠单抗与转移性结直肠癌患者的医疗成本显著降低有关。
