Truven Health Analytics, an IBM Company, Bethesda, MD.
Truven Health Analytics, an IBM Company, Bethesda, MD.
Clin Colorectal Cancer. 2017 Dec;16(4):386-396.e1. doi: 10.1016/j.clcc.2017.03.014. Epub 2017 Mar 24.
The present study examined real-world direct health care costs for metastatic colorectal cancer (mCRC) patients initiating first-line (1L) bevacizumab (BEV)- or cetuximab (CET)-containing regimen in 1L or 1L-through-second-line (1L-2L) therapy.
Using a large US insurance claims database, patients with mCRC initiating 1L BEV- or 1L CET-containing regimen from January 1, 2008 to September 30, 2014 were identified. The per-patient per-month (PPPM) all-cause health care costs (2014 US dollars) were measured during 1L therapy and, for patients continuing to a 2L biologic-containing regimen, 1L-2L therapy. Multivariable regression analyses were used to compare PPPM total health care costs between patients initiating a 1L BEV- versus 1L CET-containing regimen.
A total of 6095 patients initiating a 1L BEV- and 453 initiating a 1L CET-containing regimen were evaluated for 1L costs; 2218 patients initiating a 1L BEV- and 134 initiating a 1L CET-containing regimen were evaluated for 1L-2L costs. In 1L therapy, 1L CET had adjusted PPPM costs that were $3135 (95% confidence interval [CI], $1174-$5040; P < .001) greater on average than 1L BEV. In 1L-2L therapy, 1L BEV-2L CET had adjusted PPPM costs that were $1402 (95% CI, $1365-$1442; P = .010) greater than those for 1L BEV-2L BEV, and 1L CET-2L BEV had adjusted PPPM costs that were $4279 (95% CI, $4167-$4400; P = .001) greater on average than those for 1L BEV-2L BEV. The adjusted PPPM cost differences for 1L BEV-2L other biologic or 1L CET-2L other biologic agent were numerically greater but statistically insignificant.
PPPM total health care costs for 1L and 2L therapy tended to be greater for patients treated with 1L CET-containing regimens than for 1L BEV-containing regimens. Also, continuing treatment with BEV-containing regimens 1L-2L was less costly than switching between BEV and CET. The cost differences between BEV and CET hold important implications for treatment decisions of mCRC patients in real-world clinical practice.
本研究旨在考察转移性结直肠癌（mCRC）患者在一线（1L）贝伐珠单抗（BEV）或西妥昔单抗（CET）治疗或 1L-2L 二线治疗中接受一线（1L）BEV 或 CET 方案治疗的真实世界直接医疗成本。
利用美国大型医保理赔数据库，筛选 2008 年 1 月 1 日至 2014 年 9 月 30 日期间接受 1L BEV 或 1L CET 方案治疗的 mCRC 患者。在 1L 治疗期间，以 2014 年美元衡量每位患者每月的全因医疗费用（PPPM），对于继续接受 2L 生物制剂治疗的患者，还测量 1L-2L 治疗期间的 PPPM 总医疗费用。采用多变量回归分析比较接受 1L BEV 与 1L CET 方案治疗的患者的 PPPM 总医疗成本。
共有 6095 例患者接受 1L BEV 治疗，453 例患者接受 1L CET 治疗，用于评估 1L 成本；2218 例患者接受 1L BEV 治疗，134 例患者接受 1L CET 治疗，用于评估 1L-2L 成本。在 1L 治疗中，1L CET 的调整后 PPPM 成本平均比 1L BEV 高 3135 美元（95%CI，1174-5040；P<0.001）。在 1L-2L 治疗中，1L BEV-2L CET 的调整后 PPPM 成本比 1L BEV-2L BEV 高 1402 美元（95%CI，1365-1442；P=0.010），而 1L CET-2L BEV 的调整后 PPPM 成本比 1L BEV-2L BEV 高 4279 美元（95%CI，4167-4400；P=0.001）。接受 1L BEV-2L 其他生物制剂或 1L CET-2L 其他生物制剂治疗的患者，其调整后 PPPM 成本差异虽然更大，但无统计学意义。
接受 1L CET 方案治疗的患者的 1L 和 2L 治疗的总医疗成本往往高于接受 1L BEV 方案治疗的患者。此外，1L-2L 继续使用 BEV 方案治疗比在 BEV 和 CET 之间切换更具成本效益。在真实世界的临床实践中，BEV 和 CET 的成本差异对 mCRC 患者的治疗决策具有重要意义。
