IBM Watson Health, Cambridge, MA, USA.
AstraZeneca, Gaithersburg, MD, USA.
J Med Econ. 2021 Jan-Dec;24(1):328-338. doi: 10.1080/13696998.2021.1885418.
Non-small cell lung cancer (NSCLC) with brain metastases (BM) is difficult to treat and associated with poor survival. This study assessed the impact of BM on healthcare-related utilization and costs (HRUC) among patients receiving epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs).
Adults newly-diagnosed with metastatic NSCLC, initiating first-/second-generation EGFR-TKI treatment, with BM or no BM (NBM), were identified retrospectively from IBM MarketScan healthcare claims databases (2013-2017). HRUC were measured during the variable-length follow-up period. Generalized linear models assessed the impact of BM on total healthcare costs, standardized to 2017 US$.
Overall, 222 BM and 280 NBM patients were included, with a mean duration of follow-up of 14 months. Adjusted NSCLC-related and all-cause costs over average follow-up were 1.2 times higher among BM patients (Δ$5,640 and Δ$6,366, respectively; <0.05); differences were driven primarily by radiation treatment and radiology. More than two times more BM than NBM patients received NSCLC-related radiation treatment, in both inpatient (15.3% vs 6.8%; <0.05) and outpatient settings (87.8% vs 37.5%; <0.05). Per-patient per-month (PPPM) radiation costs were also higher among BM patients, both inpatient ($796 vs $464, =0.172) and outpatient ($2,443 vs $747, <0.05). All-cause PPPM radiology visits (2.0 vs 1.3) and associated costs ($3,824 vs $1,621) were higher among BM patients (both <0.05).
NSCLC-related HRUC, especially those attributable to radiation treatment, were higher among patients with BM. Future research should compare the potential for CNS-active EGFR-TKIs vs first-/second-generation EGFR-TKIs combined with radiotherapy to reduce HRUC.
患有脑转移（BM）的非小细胞肺癌（NSCLC）难以治疗，且生存预后较差。本研究评估了 BM 对接受表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗的转移性 NSCLC 患者的医疗保健相关利用和成本（HRUC）的影响。
本研究从 IBM MarketScan 医疗保健索赔数据库（2013-2017 年）中回顾性地确定了新诊断为转移性 NSCLC、开始接受第一代/第二代 EGFR-TKI 治疗、有 BM 或无脑转移（NBM）的成年人。在可变长度的随访期间测量 HRUC。使用广义线性模型评估 BM 对以 2017 年美元标准化的总医疗保健成本的影响。
总体而言，纳入了 222 名 BM 患者和 280 名 NBM 患者，平均随访时间为 14 个月。BM 患者的 NSCLC 相关和全因成本在平均随访期间高出 1.2 倍（分别为Δ$5,640 和 Δ$6,366； <0.05）；差异主要由放疗和放射学治疗驱动。BM 患者接受 NSCLC 相关放疗的比例是 NBM 患者的两倍多，无论是在住院（15.3%比 6.8%； <0.05）还是门诊环境（87.8%比 37.5%； <0.05）。BM 患者的每位患者每月（PPPM）放疗费用也更高，住院治疗者为$796 比$464（=0.172），门诊治疗者为$2,443 比$747（ <0.05）。BM 患者的全因 PPPM 放射学就诊次数（2.0 比 1.3）和相关费用（$3,824 比$1,621）更高（均 <0.05）。
BM 患者的 NSCLC 相关 HRUC 更高，尤其是与放疗相关的 HRUC 更高。未来的研究应该比较中枢神经系统活性 EGFR-TKIs 与第一代/第二代 EGFR-TKIs 联合放疗降低 HRUC 的潜力。
