Bonafede Machaon M, Korytowsky Beata, Singh Prianka, Cai Qian, Cappell Katherine, Jariwala-Parikh Krutika, Sill Bruce, Parikh Neehar D
IBM Watson Health (formerly Truven Health Analytics Inc.), 75 Binney Street, Cambridge, MA, 02142, USA.
Bristol-Myers Squibb, Princeton, NJ, USA.
J Gastrointest Cancer. 2020 Mar;51(1):217-226. doi: 10.1007/s12029-019-00230-z.
This study examined clinical and economic outcomes among patients with advanced hepatocellular carcinoma (HCC) treated with systemic agents by line of therapy.
Adults with ≥ 2 medical claims for primary diagnosed HCC (from January 1, 2008, through September 30, 2015) and ≥ 1 claim for systemic HCC-related therapy were identified in the IBM MarketScan® Research Databases. Continuous enrollment was required 6 months before and 1 month after diagnosis. Patients were categorized into first- (1L) and second-line (2L) treatment cohorts; those receiving sorafenib as 1L were evaluated. Treatment patterns, healthcare resource utilization, costs, and survival during 1L and 2L therapy were measured. Survival was assessed for patients linked to the Social Security Administration Master Death File.
1459 patients, 758 with death data, met the 1L cohort criteria; 163 patients, 87 with death data, later received 2L therapy. 77.1% had 1L sorafenib, alone or in combination. Median 1L treatment duration was 3.0 months; median survival time from start of 1L to death or censor was 6.8 months. There was no predominant 2L agent. Median 2L treatment duration was 3.0 months; median survival time from start of 2L was 9.3 months. Median total healthcare costs per patient per month were $13,297 for 1L (all), $13,471 for 1L (sorafenib), and $11,786 for 2L.
Findings confirm high 1-year mortality for advanced HCC, suggesting a high cost burden. While no 2L therapy was available during this analysis, recently approved 2L agents have the potential to improve survival after sorafenib failure or intolerance.
本研究按治疗线数考察了接受全身治疗药物的晚期肝细胞癌（HCC）患者的临床和经济结局。
在IBM MarketScan®研究数据库中识别出患有原发性诊断HCC且有≥2份医疗理赔记录（从2008年1月1日至2015年9月30日）以及≥1份与HCC相关的全身治疗理赔记录的成年人。在诊断前6个月和诊断后1个月需要持续入组。患者被分为一线（1L）和二线（2L）治疗队列；对接受索拉非尼作为一线治疗的患者进行评估。测量了一线和二线治疗期间的治疗模式、医疗资源利用、成本和生存情况。对与社会保障管理局主死亡档案相关联的患者进行了生存评估。
1459名患者符合一线队列标准，其中758名有死亡数据；163名患者后来接受了二线治疗，其中87名有死亡数据。77.1%的患者接受了单独或联合使用的一线索拉非尼治疗。一线治疗的中位持续时间为3.0个月；从一线治疗开始到死亡或 censored 的中位生存时间为6.8个月。没有占主导地位的二线药物。二线治疗的中位持续时间为3.0个月；从二线治疗开始的中位生存时间为9.3个月。每位患者每月的中位总医疗成本，一线治疗（全部）为13,297美元，一线治疗（索拉非尼）为13,471美元，二线治疗为11,786美元。
研究结果证实晚期HCC的1年死亡率很高，表明成本负担沉重。虽然在本次分析期间没有可用的二线治疗方法，但最近获批的二线药物有可能改善索拉非尼治疗失败或不耐受后的生存情况。
