Vekeman Francis, Cloutier Michel, Yermakov Sander, Amonkar Mayur M, Arondekar Bhakti, Duh Mei S
aGroupe d'analyse Ltée, Montreal, Quebec, Canada bAnalysis Group Inc., Boston, Massachusetts, USA cGlaxoSmithKline, Philadelphia, Pennsylvania, USA.
Melanoma Res. 2014 Dec;24(6):602-10. doi: 10.1097/CMR.0000000000000097.
Malignant melanoma patients frequently relapse with metastases in the brain, making it the third most common cancer-causing brain metastases in the USA. Management of brain metastases remains challenging because of the rapid progression of disease and ineffectiveness of conventional therapies. This retrospective study, with a 'pre/post' design, quantifies the economic burden of brain metastases among melanoma patients in the USA. A large managed-care insurance claims database (2000 Q1-2011 Q3) was used to identify patients with melanoma and brain metastases. The preperiod was defined as the 6 months before the index date (diagnosis of first observed brain metastases) and postperiod as the period following the index date up to 12 months. All-cause and brain metastasis-related healthcare resource utilization and healthcare costs were compared on a per-patient-per-month (PPPM) basis between preperiods and postperiods. The study included 6076 patients (mean age 63.4 years); 57.6% were men. Significant differences (P<0.0001) were observed between the postperiods and preperiods in the mean all-cause and brain metastasis-related PPPM hospitalizations and emergency department and outpatient visits. Significant postperiod versus preperiod differences were also observed in the PPPM mean (standard error) all-cause healthcare costs [total: $14 489 ($231) vs. $7277 ($116); inpatient: $6330 ($195) vs. $1900 ($69); outpatient: $6609 ($102) vs. $4449 ($79); P<0.0001 for all] and brain metastasis-related costs [total: $6542 ($145) vs. $1933 ($62); inpatient: $2976 ($118) vs. $472 ($39); outpatient: $3451 ($76) vs. $1413 ($47); P<0.0001 for all]. Radiotherapy was the most common treatment. The economic burden associated with brain metastases in melanoma is significant and underscores the need for newer therapies to improve outcomes in these patients.
恶性黑色素瘤患者常因脑转移而复发，这使其成为美国第三大导致脑转移的常见癌症。由于疾病进展迅速且传统疗法效果不佳，脑转移的治疗仍然具有挑战性。这项采用“前后”设计的回顾性研究，量化了美国黑色素瘤患者脑转移的经济负担。利用一个大型管理式医疗保险理赔数据库（2000年第一季度至2011年第三季度）来识别患有黑色素瘤和脑转移的患者。前期定义为索引日期（首次观察到脑转移的诊断）前6个月，后期定义为索引日期后至12个月的时间段。在前期和后期之间，按每位患者每月（PPPM）比较全因和与脑转移相关的医疗资源利用及医疗费用。该研究纳入了6076例患者（平均年龄63.4岁）；57.6%为男性。在后期和前期之间，观察到全因和与脑转移相关的PPPM住院、急诊科就诊和门诊就诊的平均数存在显著差异（P<0.0001）。在PPPM平均（标准误）全因医疗费用方面（总体：14489美元（231美元）对7277美元（116美元）；住院：6330美元（195美元）对1900美元（69美元）；门诊：6,609美元（102美元）对4,449美元（79美元）；所有P<0.0001）以及与脑转移相关的费用方面（总体：6542美元（145美元）对1933美元（62美元）；住院：2976美元（118美元）对472美元（39美元）；门诊：3451美元（76美元）对1413美元（47美元）；所有P<0.0001），后期与前期也存在显著差异。放疗是最常见的治疗方法。黑色素瘤脑转移相关的经济负担很重，这凸显了需要更新的疗法来改善这些患者的治疗结果。
