Chawla Anita, Peeples Miranda, Li Nanxin, Anhorn Rachel, Ryan Jason, Signorovitch James
a Analysis Group, Inc. , Menlo Park , CA , USA.
b Analysis Group, Inc. , Boston , MA , USA.
J Med Econ. 2018 Jun;21(6):543-552. doi: 10.1080/13696998.2017.1423488. Epub 2018 Jan 19.
To assess the frequency of biopsies and molecular diagnostic testing (human DNA/RNA analysis), anti-cancer drug use (genomically-matched targeted therapy [GMTT], unmatched targeted therapy [UTT], endocrine therapy [ET], and chemotherapy [CT]), and medical service costs among adults with metastatic cancer.
Adults diagnosed with metastatic breast, non-small cell lung (NSCLC), colorectal, head and neck, ovarian, and uterine cancer (2010Q1-2015Q1) were identified in the OptumHealth Care Solutions claims database and followed from first metastatic diagnosis for ≥1 month and until the end of data availability. Utilization was assessed for each cancer cohort (all and patients aged ≥65 years); per-patient-per-month (PPPM) medical service costs were assessed for all patients. Testing frequency estimates were applied to Surveillance, Epidemiology, and End Results Program data to estimate the number of untested patients (2010-2014).
Patients with metastatic cancer (n = 8,193; breast [n = 3,414], NSCLC [n = 2,231], colorectal [n = 1,611], head and neck [n = 511], ovarian [n = 275], and uterine [n = 151]) were 63 years old (mean), with 11.1-22.2 months of observation. Biopsy and molecular diagnostic testing frequencies ranged from 7% (uterine) to 73% (ovarian), and from 34% (head and neck) to 52% (breast), respectively. Few were treated with GMTT (breast, 11%; NSCLC, 9%; colorectal, 6%). Treatment with UTT ranged from 0.7% (uterine) to 21% (colorectal). Biopsy, diagnostic testing, and anti-cancer drug therapy were less frequent for those ≥65 years. Medical service costs (PPPM, mean) ranged from $6,618 (head and neck) to $9,940 (ovarian). The estimated number of untested new patients with metastatic cancer was 636,369 (all) and 341,397 (≥65).
In addition to the limitations of claims analyses, diagnostic testing frequency may be under-estimated if patients underwent testing prior to study inclusion.
The low frequency of molecular diagnostic testing suggests there are opportunities to better inform management of patients with advanced cancer, particularly decisions to treat with GMTT.
评估转移性癌症成年患者的活检和分子诊断检测（人类DNA/RNA分析）频率、抗癌药物使用情况（基因组匹配靶向治疗[GMTT]、非匹配靶向治疗[UTT]、内分泌治疗[ET]和化疗[CT]）以及医疗服务成本。
在OptumHealth Care Solutions理赔数据库中识别出2010年第一季度至2015年第一季度被诊断为转移性乳腺癌、非小细胞肺癌（NSCLC）、结直肠癌、头颈癌、卵巢癌和子宫癌的成年患者，并从首次转移性诊断起随访≥1个月，直至数据可用期末。评估每个癌症队列（所有患者以及年龄≥65岁的患者）的利用率；评估所有患者的每月人均医疗服务成本（PPPM）。将检测频率估计值应用于监测、流行病学和最终结果计划数据，以估计未检测患者的数量（2010 - 2014年）。
转移性癌症患者（n = 8193；乳腺癌[n = 3414]、NSCLC[n = 2231]、结直肠癌[n = 1611]、头颈癌[n = 511]、卵巢癌[n = 275]和子宫癌[n = 151]）的平均年龄为63岁，观察时间为11.1 - 22.2个月。活检和分子诊断检测频率分别为7%（子宫癌）至73%（卵巢癌），以及34%（头颈癌）至52%（乳腺癌）。接受GMTT治疗的患者很少（乳腺癌，11%；NSCLC，9%；结直肠癌，6%）。接受UTT治疗的比例从0.7%（子宫癌）至21%（结直肠癌）不等。65岁及以上患者的活检、诊断检测和抗癌药物治疗频率较低。医疗服务成本（PPPM，平均值）从6618美元（头颈癌）至9940美元（卵巢癌）不等。估计未检测到的转移性癌症新患者数量为636369例（所有患者）和341397例（年龄≥65岁）。
除了理赔分析的局限性外，如果患者在纳入研究之前接受了检测，诊断检测频率可能被低估。
分子诊断检测频率较低表明有机会更好地为晚期癌症患者的管理提供信息，特别是关于GMTT治疗的决策。
