Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.
Health Serv Res. 2021 Jun;56(3):486-496. doi: 10.1111/1475-6773.13624. Epub 2021 Mar 7.
To examine the population-level impacts of the introduction of novel cancer therapies with high cost in the United States, using immunotherapies in advanced nonsmall cell lung cancer (NSCLC) as an example.
Surveillance, Epidemiology, and End Results data in 2012-2015 linked to Medicare fee-for-service claims until 2016.
We examined population-level trends in treatment patterns, survival, and Medicare spending in patients diagnosed with advanced NSCLC, the leading cause of cancer death in the United States, between 2012 and 2015. We estimated the percentage of patients who received any antineoplastic therapy within two years of diagnosis, including novel immunotherapies. We compared the trends in overall survival and mean two-year Medicare spending per each patient before and after the introduction of immunotherapies in 2015.
DATA COLLECTION/EXTRACTION METHODS: Not Applicable.
The percentage of patients treated with any antineoplastic therapy remained the same at 46.7% in 2012 and 2015, whereas the use of immunotherapies increased from 0% to 15.2%. The two-year survival rate and median survival increased by 3.3 percentage points (95% CI: 2.0, 4.5) and 0.4 months (CI: 0.0, 0.9), respectively, during the same period. The mean two-year total Medicare spending and outpatient spending per patient increased by $5735 (CI: 3479, 8040) and $7661 (CI: 5902, 9311), respectively, which were largely attributable to the increases in immunotherapy spending by $5806 (CI: 5165, 6459).
The introduction of lung cancer immunotherapies was accompanied by improvements in survival and increases in spending between 2012 and 2015 in the Medicare population. As novel immunotherapies and other target therapies continue to change the clinical management of various cancers, further efforts are needed to ensure their effective and efficient use, and to understand their population-level impacts in the United States.
以晚期非小细胞肺癌（NSCLC）中的免疫疗法为例，研究美国新型高成本癌症疗法问世对人群的影响。
2012-2015 年监测、流行病学和最终结果数据，以及 2016 年之前的医疗保险费用报销数据。
我们研究了 2012 年至 2015 年期间，在美国导致癌症死亡的主要原因——晚期 NSCLC 患者的治疗模式、生存和医疗保险支出的人群水平趋势。我们估计了在诊断后两年内接受任何抗肿瘤治疗的患者比例，包括新型免疫疗法。我们比较了在 2015 年免疫疗法问世前后，总体生存率和每位患者两年期医疗保险支出的平均水平的变化趋势。
数据收集/提取方法：不适用。
接受任何抗肿瘤治疗的患者比例在 2012 年和 2015 年分别保持在 46.7%不变，而免疫疗法的使用比例从 0%增加到 15.2%。同期，两年生存率和中位生存时间分别提高了 3.3 个百分点（95%置信区间：2.0，4.5）和 0.4 个月（置信区间：0.0，0.9）。每位患者两年期医疗保险总支出和门诊支出的平均值分别增加了 5735 美元（置信区间：3479，8040）和 7661 美元（置信区间：5902，9311），这主要归因于免疫疗法支出增加了 5806 美元（置信区间：5165，6459）。
在 Medicare 人群中，2012 年至 2015 年间，肺癌免疫疗法的问世带来了生存的改善和支出的增加。随着新型免疫疗法和其他靶向疗法继续改变各种癌症的临床管理，需要进一步努力确保它们的有效和高效使用，并了解它们在美国的人群水平影响。
