Alatorre Jorge Arturo, Campos-Gómez Saúl, De la Mora Emmanuel, Novick Diego, Cruz Angélica, Iglesias-Chiesa Jimena María
National Institute of Respiratory Diseases, Mexico City, Mexico.
Department of Medical Oncology, State Oncology Center, Social Security Institute of the State of Mexico and Municipalities, Mexico City, State of Mexico, Mexico.
Pharmacoecon Open. 2020 Jun;4(2):381-388. doi: 10.1007/s41669-019-00174-x.
The available evidence regarding the clinical characteristics, treatment patterns, adverse events (AEs), and costs of treating patients with stage IV non-small cell lung cancer (NSCLC) in Mexico is scarce.
Our objective was to describe the clinical characteristics, treatment patterns, and direct costs associated with Mexican patients diagnosed with stage IV NSCLC who had completed two or more lines of systemic antineoplastic treatment.
A multicenter retrospective cohort study was designed to collect data from the medical records of patients treated at tertiary-level public hospitals in Mexico (multicenter chart review). We calculated costs from the viewpoint of payers based on data regarding therapy and service utilization.
A total of 115 patients were included. Median patient age was 61 years (interquartile range [IQR] 52.4-68.5), and 51.3% were female. The most common NSCLC type was non-squamous (92.2%), and the typical histology was adenocarcinoma (88.7%). All patients received first- and second-line therapy: 54.78% completed a third-line, 27.82% a fourth-line, 7.82% a fifth-line, 2.6% a sixth-line, and 1.7% a seventh-line active therapy. Carboplatin was the most frequently used therapy (28.6%) followed by docetaxel (23.3%), nivolumab (16.7%), and irinotecan (13.3%). AEs occurred in 53% of the patients and none was fatal. In total, 59 patients (51.3%) required hospitalization during the observation period. The median cost per patient was $US7039.40, with a minimum of $US628.30 and a maximum of $US3,557,364.20. Median overall survival of the cohort was 12 months (95% confidence interval 9.8-14.1).
In Mexico, NSCLC is usually diagnosed at stage IV. This study shows considerable variation in chemotherapy regimens, leading to a wide range in treatment cost. The understanding of NSCLC treatment patterns in Mexico will help to identify and address unmet needs.
关于墨西哥IV期非小细胞肺癌（NSCLC）患者的临床特征、治疗模式、不良事件（AE）及治疗费用的现有证据匮乏。
我们的目的是描述已完成两线或更多线全身抗肿瘤治疗的墨西哥IV期NSCLC确诊患者的临床特征、治疗模式及直接费用。
设计了一项多中心回顾性队列研究，以收集墨西哥三级公立医院接受治疗患者的病历数据（多中心病历审查）。我们根据治疗和服务利用数据，从支付方的角度计算费用。
共纳入115例患者。患者中位年龄为61岁（四分位间距[IQR]52.4 - 68.5），51.3%为女性。最常见的NSCLC类型为非鳞状（92.2%），典型组织学类型为腺癌（88.7%）。所有患者均接受了一线和二线治疗：54.78%完成了三线治疗，27.82%完成了四线治疗，7.82%完成了五线治疗，2.6%完成了六线治疗，1.7%完成了七线积极治疗。卡铂是最常用的治疗药物（28.6%），其次是多西他赛（23.3%）、纳武单抗（16.7%）和伊立替康（13.3%）。53%的患者发生了AE，无一例致命。在观察期内，共有59例患者（51.3%）需要住院治疗。每位患者的中位费用为7039.40美元，最低为628.30美元，最高为3557364.20美元。该队列的中位总生存期为12个月（95%置信区间9.8 - 14.1）。
在墨西哥，NSCLC通常在IV期确诊。本研究显示化疗方案存在显著差异，导致治疗费用范围广泛。了解墨西哥NSCLC的治疗模式将有助于识别和满足未满足的需求。
