在新诊断为转移性尿路上皮癌的 Medicare 患者中，按治疗线评估的总生存期、成本和医疗资源使用情况。
Overall survival, costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma.
机构信息
a Real-World Evidence and Data Analytics, Pharmerit International , Bethesda , MD , USA.
b US Health Economics Outcomes Research, Bristol-Myers Squibb , Princeton , NJ , USA.
出版信息
J Med Econ. 2019 Jul;22(7):662-670. doi: 10.1080/13696998.2019.1591424. Epub 2019 Mar 25.
Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT), but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, the economic burden of chemotherapy-based mUC treatments among US Medicare patients was estimated. Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third or greater [LOT3+]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, and maximum LOT received. Among 1,873 eligible patients with mUC (median age = 77 years; median follow-up = 7.5 months), 1,035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had LOT3+. Median OS was 8.1 months, range was 4.3 (untreated) to 29.8 (LOT3+) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated = $57,207; LOT1 = $99,213; LOT2 = $125,190; LOT3+ = $163,884). Mean per patient per month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated = $27,211; LOT1 = $9,601; LOT2 = $7,325; LOT3+ = $6,017). Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients. Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically relevant economic benchmark for mUC treatment across different traditional LOTs.
医保患者转移性或不可切除的尿路上皮癌（mUC）常采用铂类化疗作为一线治疗（LOT），但通常会进展，需要更多的 LOT 和医疗资源使用（HCRU）。为了更好地了解不断发展的 mUC 治疗领域，对美国医保患者基于化疗的 mUC 治疗的经济负担进行了估计。从监测、流行病学和最终结果（SEER）-医疗保险数据库中确定了新诊断的 mUC 医保患者。从诊断到死亡、退出或研究结束，对 LOT （一线[LOT1]、二线[LOT2]和三线或更多[LOT3+]）进行随访。采用 Kaplan-Meier 方法估计 LOT 的总生存期（OS）。报告了随访期间、LOT 持续时间和接受的最大 LOT 的 HCRU 和平均费用。在 1873 名符合条件的 mUC 患者（中位年龄=77 岁；中位随访=7.5 个月）中，有 1035 名（55%）未接受化疗。在接受化疗的患者中，61%仅接受 LOT1，25%仅接受 LOT1 和 LOT2，14%接受 LOT3+。中位 OS 为 8.1 个月，范围为 4.3（未治疗）至 29.8（LOT3+）个月。随着 LOT 的增加，HCRU 的频率增加。所有患者的平均累积每位患者费用为 82912 美元，随着 LOT 的增加而增加（未治疗=57207 美元；LOT1=99213 美元；LOT2=125190 美元；LOT3+=163884 美元）。所有患者的平均每月每位患者费用为 18827 美元，随着接受 LOT 数量的增加而减少（未治疗=27211 美元；LOT1=9601 美元；LOT2=7325 美元；LOT3+=6017 美元）。使用定义 LOT 的算法存在治疗分类错误的可能性，并且结果不能推广到年轻患者。超过 50%的 mUC 医保患者未接受化疗。在接受化疗的患者中，大多数仅接受一个 LOT。更多的 LOT 会导致更高的平均成本和 HCRU，但随着患者的随访时间延长，每月成本会降低。随着治疗方法的发展，包括免疫肿瘤学药物，这些发现为不同传统 LOT 的 mUC 治疗提供了具有临床意义的经济基准。
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