OptumInsight, 12125 Technology Drive, Eden Prairie, MN 55344, USA.
Oncologist. 2013;18(1):37-45. doi: 10.1634/theoncologist.2012-0113. Epub 2013 Jan 8.
. Treatment of multiple myeloma has dramatically improved with the introduction of bortezomib (BOR), thalidomide (THAL), and lenalidomide (LEN). Studies assessing health care costs, particularly economic burden on patients, are limited. We conducted a claims-based, retrospective analysis of total health care costs as well as patient burden (patient out-of-pocket costs and number of ambulatory/hospital visits) associated with BOR/THAL/LEN treatment versus other therapies (OTHER). METHODS. Treatment episodes starting between January 1, 2005 and September 30, 2010 were identified from the claims database of a large U.S. health plan. Health care costs and utilization were measured during 1 year after initiation and analyzed per treatment episode. Multivariate analyses were used to adjust for patient characteristics, comorbidities, and line of treatment.
A total of 4,836 treatment episodes were identified. Mean adjusted total costs were similar between BOR ($112,889) and OTHER ($111,820), but higher with THAL ($129,412) and LEN ($158,428). Mean adjusted patient out-of-pocket costs were also similar for BOR ($3,846) and OTHER ($3,900) but remained higher with THAL ($4,666) and LEN ($4,483). Mean adjusted rates of ambulatory visits were similar across therapies (BOR: 69.67; THAL: 66.31; LEN: 65.60;
69.42).
Adjusted analyses of real-world claims data show that total health care costs, as well as patient out-of-pocket costs, are higher with THAL/LEN treatment episodes than with BOR/OTHER therapies. Additionally, similar rates of ambulatory visits suggest that any perceived advantage in patient convenience of the orally administered drugs THAL/LEN is not supported by these data.
随着硼替佐米(BOR)、沙利度胺(THAL)和来那度胺(LEN)的引入,多发性骨髓瘤的治疗有了显著改善。评估医疗保健成本的研究,特别是患者的经济负担,是有限的。我们进行了一项基于索赔的回顾性分析,评估了与 BOR/THAL/LEN 治疗相比,其他治疗(OTHER)的总医疗保健成本以及与患者相关的负担(患者自付费用和门诊/住院就诊次数)。
从美国一个大型健康计划的索赔数据库中确定了 2005 年 1 月 1 日至 2010 年 9 月 30 日期间开始的治疗期。在开始治疗后的 1 年内测量医疗保健费用和使用情况,并按每个治疗期进行分析。使用多变量分析来调整患者特征、合并症和治疗线。
共确定了 4836 个治疗期。BOR(112889 美元)和 OTHER(111820 美元)的调整后总费用相似,但 THAL(129412 美元)和 LEN(158428 美元)的费用更高。BOR(3846 美元)和 OTHER(3900 美元)的调整后患者自付费用也相似,但 THAL(4666 美元)和 LEN(4483 美元)的费用仍然较高。治疗方法的调整后门诊就诊率相似(BOR:69.67;THAL:66.31;LEN:65.60;OTHER:69.42)。
真实世界索赔数据的调整分析表明,与 BOR/OTHER 治疗相比,THAL/LEN 治疗的总医疗保健成本以及患者自付费用更高。此外,相似的门诊就诊率表明,THAL/LEN 作为口服药物在患者便利性方面的任何优势都没有得到这些数据的支持。