Kunisawa Susumu, Tange Chihiro, Shimozuma Kojiro
Department of Biomedical Sciences, Ritsumeikan University, Nojihigashi 1-1-1, Kusatsu, 525-8577 Shiga Japan.
Springerplus. 2015 Oct 19;4:624. doi: 10.1186/s40064-015-1413-9. eCollection 2015.
Previous cost-effectiveness analyses (CEAs) of abiraterone for castration-resistant prostate cancer (CRPC) patients have not shown favorable results for this new drug. These CEAs were generally conducted based on models used in clinical trials, where comparisons were made with patients given placebos. However, details on any other therapies provided to the comparison groups were not analyzed. These additional therapies should be considered when conducting CEAs to ensure better applications to clinical practice and policymaking. The objective of this study was to elucidate the actual therapies provided to CRPC patients using real-world claims data. We obtained anonymized computerized health care claims data of Japanese prostate cancer patients from the Japan Medical Data Center. This database comprises data from more than 2.5 million insured persons aged below 75 years from over 50 companies between January 2005 and June 2013. From among the prostate cancer patients, we identified CRPC patients as those who had been administered docetaxel, and further investigated their treatments and health care costs. Health care costs were estimated using a regression model accounting for variations in inpatient care, chemotherapies, death, and age. We identified 2138 prostate cancer patients, 36 of whom had been administered docetaxel. We excluded patients diagnosed with other cancers, resulting in a final sample of 18 cases. Of these, 66.7 % were administered other types of chemotherapy, which had not been considered in the control groups in most previous CEAs. We estimated mean health care costs for CRPC to be approximately US$952 per patient per month, and found that these costs were significantly affected by inpatient care and chemotherapy use. Actual therapies include a variety of treatments for CRPC patients, including various types of chemotherapy. Our study estimated health care costs based on real-world claims data. This study contributes to future CEAs by not only providing an estimate of health care costs for these patients, but also demonstrating that the actual therapies provided to comparison groups should be considered when conducting CEAs.
既往针对去势抵抗性前列腺癌（CRPC）患者使用阿比特龙的成本效益分析（CEA），并未显示出这种新药有良好的结果。这些CEA通常是基于临床试验中使用的模型进行的，在试验中与给予安慰剂的患者进行比较。然而，未对给予对照组的任何其他治疗的细节进行分析。在进行CEA时应考虑这些额外的治疗，以确保能更好地应用于临床实践和决策制定。本研究的目的是利用真实世界的理赔数据阐明给予CRPC患者的实际治疗。我们从日本医疗数据中心获取了日本前列腺癌患者匿名的计算机化医疗理赔数据。该数据库包含2005年1月至2013年6月期间来自50多家公司的超过250万75岁以下参保人员的数据。在前列腺癌患者中，我们将接受多西他赛治疗的患者确定为CRPC患者，并进一步调查他们的治疗情况和医疗费用。使用一个考虑住院治疗、化疗、死亡和年龄差异的回归模型来估算医疗费用。我们确定了2138例前列腺癌患者，其中36例接受了多西他赛治疗。我们排除了诊断为其他癌症的患者，最终样本为18例。其中，66.7%的患者接受了其他类型的化疗，而在大多数既往CEA的对照组中并未考虑这些化疗。我们估计CRPC患者的平均医疗费用约为每人每月952美元，并发现这些费用受住院治疗和化疗使用情况的显著影响。实际治疗包括对CRPC患者的多种治疗，包括各种类型的化疗。我们的研究基于真实世界的理赔数据估算医疗费用。本研究不仅为这些患者的医疗费用提供了估计，还表明在进行CEA时应考虑给予对照组的实际治疗，从而为未来的CEA做出了贡献。
