Karve Sudeep J, Price Gregory L, Davis Keith L, Pohl Gerhardt M, Smyth Emily Nash, Bowman Lee
RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC, 27709, USA.
Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, Indian.
BMC Health Serv Res. 2014 Nov 13;14:555. doi: 10.1186/s12913-014-0555-8.
Limited data exist regarding real-world treatment patterns, resource utilization, and costs of extensive-stage small cell lung cancer (esSCLC) among elderly patients in the United States. While abundant data are available on treatment patterns in metastatic non-small cell lung cancer (mNSCLC), to our knowledge no data exist comparing costs and resource use between patients with esSCLC or mNSCLC.
We retrospectively analyzed administrative claims data (2000-2008) of patients aged ≥65 years from the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database. Patients were selected on the basis of having newly diagnosed esSCLC (n=5,855) or mNSCLC (n=24,090) during 1/1/2000-12/31/2005, and were required to have received cancer-directed therapy. Survival and other measures were compared between esSCLC and mNSCLC patients using Kaplan-Meier log-rank and univariate chi-square and t-tests. Study measures were followed from first diagnosis date of either esSCLC or mNSCLC until the earlier of death or end of the database.
Survival between the cohorts did not differ significantly: mean of 10.4 months for esSCLC patients versus 11.1 months for mNSCLC; median survival was 7.4 months versus 5.9 months. A higher percentage of mNSCLC patients (vs. esSCLC) received radiation therapy (75.6% vs. 65.4%; P < 0.001) and surgery (13.6% vs. 7.8%; P < 0.001) during the metastatic disease period. Conversely, a higher percentage of esSCLC patients than mNSCLC patients received chemotherapy (85.5% vs. 60.3%; P < 0.001), red blood-cell transfusion (20.7% vs. 10.9%; P < 0.001), platelet transfusion (5.6% vs. 1.8%; P < 0.001), and growth-factor support (59.0% vs. 39.5%; P < 0.001). esSCLC patients incurred higher lifetime disease-related costs ($44,167 vs. $37,932; P < 0.001) and all-cause costs ($70,549 vs. $67,176; P < 0.001) than mNSCLC patients.
Lifetime total and disease-related costs per patient were high. Increased use of chemotherapy, supportive care therapies (including growth factors), and disease-related hospitalizations were observed in esSCLC patients as compared with mNSCLC patients. Disease-related and all-cause costs for esSCLC also exceeded those of mNSCLC, except for hospice and skilled nursing services. Survival and per-patient costs for both groups underscore the unmet medical need for more effective therapies in patients with esSCLC or mNSCLC.
关于美国老年患者广泛期小细胞肺癌（esSCLC）的实际治疗模式、资源利用和成本的数据有限。虽然有大量关于转移性非小细胞肺癌（mNSCLC）治疗模式的数据，但据我们所知，尚无比较esSCLC或mNSCLC患者成本和资源使用情况的数据。
我们回顾性分析了来自关联的监测、流行病学和最终结果（SEER）-医疗保险数据库中年龄≥65岁患者的行政索赔数据（2000 - 2008年）。患者基于在2000年1月1日至2005年12月31日期间新诊断为esSCLC（n = 5855）或mNSCLC（n = 24090）进行选择，并要求接受了针对癌症的治疗。使用Kaplan-Meier对数秩检验以及单变量卡方检验和t检验比较esSCLC和mNSCLC患者的生存率及其他指标。研究指标从esSCLC或mNSCLC的首次诊断日期开始跟踪，直至死亡或数据库结束的较早时间。
队列之间的生存率无显著差异：esSCLC患者的平均生存期为10.4个月，而mNSCLC患者为11.1个月；中位生存期分别为7.4个月和5.9个月。在转移性疾病期间，接受放射治疗的mNSCLC患者比例更高（75.6%对65.4%；P < 0.001），接受手术的比例也更高（13.6%对7.8%；P < 0.001）。相反，接受化疗的esSCLC患者比例高于mNSCLC患者（85.5%对60.3%；P < 0.001），接受红细胞输血的比例更高（20.7%对10.9%；P < 0.001），接受血小板输血的比例更高（5.6%对1.8%；P < 0.001），接受生长因子支持的比例更高（59.0%对39.5%；P < 0.001）。esSCLC患者的终身疾病相关成本（44167美元对37932美元；P < 0.001）和全因成本（70549美元对67176美元；P < 0.001）高于mNSCLC患者。
每位患者的终身总成本和疾病相关成本都很高。与mNSCLC患者相比，esSCLC患者化疗、支持性护理疗法（包括生长因子）以及与疾病相关的住院治疗的使用增加。除临终关怀和专业护理服务外，esSCLC的疾病相关成本和全因成本也超过了mNSCLC。两组的生存率和每位患者的成本凸显了esSCLC或mNSCLC患者对更有效治疗的未满足医疗需求。
