Survival, costs, and health care resource use by line of therapy in US Medicare patients with newly diagnosed glioblastoma: a retrospective observational study.
costs
glioblastoma
line of therapy
resource use
survival
Journal
Neuro-oncology practice
ISSN: 2054-2577
Titre abrégé: Neurooncol Pract
Pays: England
ID NLM: 101640528
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
entrez:
7
7
2020
pubmed:
7
7
2020
medline:
7
7
2020
Statut:
ppublish
Résumé
Glioblastoma (GBM) is associated with poor prognosis, large morbidity burden, and limited treatment options. This analysis evaluated real-world treatment patterns, overall survival, resource use, and costs among Medicare patients with GBM. This retrospective observational study evaluated Medicare patients age 66 years or older with newly diagnosed GBM using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2007 through 2013. Patients were followed from diagnosis to death or end of follow-up. An algorithm defined treatment patterns as lines of therapy (LOTs). The Kaplan-Meier method was used to estimate overall survival for the full sample as well as by LOT, surgical resection, Charlson Comorbidity Index (CCI), tumor size, and age. Resource use and costs during the follow-up period were reported in terms of total and per-patient-per-month (PPPM) estimates. A total of 4308 patients with GBM were identified (median age, 74 years; CCI of 0, 52%). The most commonly used first LOT was temozolomide (82%), whereas chemotherapy + bevacizumab was most prevalent for second-line (42%) and third-line (58%) therapy. The median overall survival was 5.9 months for resected patients and 3 months for unresected patients, with considerable heterogeneity depending on patient characteristics. A great proportion of patients had claims for an ICU admission (86.2%), skilled nursing facility (76.9%), and home health (56.0%) in the postdiagnosis period. The cumulative mean cost was $95 377 per patient and $18 053 PPPM, mostly attributed to hospitalizations. Limited treatment options, poor survival, and economic burden emphasize the need for novel interventions to improve care for Medicare patients with GBM.
Sections du résumé
BACKGROUND
BACKGROUND
Glioblastoma (GBM) is associated with poor prognosis, large morbidity burden, and limited treatment options. This analysis evaluated real-world treatment patterns, overall survival, resource use, and costs among Medicare patients with GBM.
METHODS
METHODS
This retrospective observational study evaluated Medicare patients age 66 years or older with newly diagnosed GBM using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from 2007 through 2013. Patients were followed from diagnosis to death or end of follow-up. An algorithm defined treatment patterns as lines of therapy (LOTs). The Kaplan-Meier method was used to estimate overall survival for the full sample as well as by LOT, surgical resection, Charlson Comorbidity Index (CCI), tumor size, and age. Resource use and costs during the follow-up period were reported in terms of total and per-patient-per-month (PPPM) estimates.
RESULTS
RESULTS
A total of 4308 patients with GBM were identified (median age, 74 years; CCI of 0, 52%). The most commonly used first LOT was temozolomide (82%), whereas chemotherapy + bevacizumab was most prevalent for second-line (42%) and third-line (58%) therapy. The median overall survival was 5.9 months for resected patients and 3 months for unresected patients, with considerable heterogeneity depending on patient characteristics. A great proportion of patients had claims for an ICU admission (86.2%), skilled nursing facility (76.9%), and home health (56.0%) in the postdiagnosis period. The cumulative mean cost was $95 377 per patient and $18 053 PPPM, mostly attributed to hospitalizations.
CONCLUSIONS
CONCLUSIONS
Limited treatment options, poor survival, and economic burden emphasize the need for novel interventions to improve care for Medicare patients with GBM.
Identifiants
pubmed: 32626585
doi: 10.1093/nop/npz042
pii: npz042
pmc: PMC7318856
doi:
Types de publication
Journal Article
Langues
eng
Pagination
164-175Subventions
Organisme : NCI NIH HHS
ID : HHSN261201000140C
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261201000035C
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261201000035I
Pays : United States
Organisme : NCI NIH HHS
ID : HHSN261201000034C
Pays : United States
Organisme : NCCDPHP CDC HHS
ID : U58 DP003862
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Références
Biometrics. 2012 Sep;68(3):983-9
pubmed: 23189327
Med Care. 1993 Aug;31(8):732-48
pubmed: 8336512
Cancer. 2009 Aug 1;115(15):3512-8
pubmed: 19514084
Mol Clin Oncol. 2015 Sep;3(5):971-978
pubmed: 26623036
J Neurooncol. 2012 Apr;107(2):359-64
pubmed: 22045118
BMC Cancer. 2015 Dec 29;15:1019
pubmed: 26714468
Lancet Oncol. 2012 Jul;13(7):707-15
pubmed: 22578793
Med Care. 2015 Aug;53(8):e58-64
pubmed: 23552436
N Engl J Med. 2014 Feb 20;370(8):699-708
pubmed: 24552317
J Med Life. 2009 Oct-Dec;2(4):386-93
pubmed: 20108752
J Clin Oncol. 2011 Aug 1;29(22):3050-5
pubmed: 21709196
N Engl J Med. 2017 Mar 16;376(11):1027-1037
pubmed: 28296618
JAMA. 2017 Dec 19;318(23):2306-2316
pubmed: 29260225
Oncology (Williston Park). 2017 Jun 15;31(6):476-83
pubmed: 28620898
Am Health Drug Benefits. 2014 May;7(3):140-9
pubmed: 24991398
Curr Med Res Opin. 2018 May;34(5):813-820
pubmed: 29025274
Neurology. 2011 Jan 4;76(1):87-93
pubmed: 21205697
Clin Oncol (R Coll Radiol). 2017 Nov;29(11):739-747
pubmed: 28807361
Cancer. 2008 Mar 1;112(5):1139-46
pubmed: 18246536
Cancer Epidemiol Biomarkers Prev. 2014 Oct;23(10):1985-96
pubmed: 25053711
J Clin Oncol. 2015 Dec 10;33(35):4145-50
pubmed: 26392096
J Clin Oncol. 2010 Mar 1;28(7):1168-74
pubmed: 20124186
Neuro Oncol. 2017 May 1;19(5):669-677
pubmed: 28453749
Cancer. 2004 Nov 15;101(10):2293-9
pubmed: 15476282
EPMA J. 2016 Jul 04;7:14
pubmed: 27379174
CA Cancer J Clin. 2010 May-Jun;60(3):166-93
pubmed: 20445000
Am Soc Clin Oncol Educ Book. 2017;37:175-186
pubmed: 28561663
Lancet Oncol. 2014 Aug;15(9):943-53
pubmed: 25035291
Radiat Oncol. 2017 Dec 6;12(1):197
pubmed: 29212499
Lancet Oncol. 2012 Sep;13(9):916-26
pubmed: 22877848
N Engl J Med. 2005 Mar 10;352(10):997-1003
pubmed: 15758010
J Med Econ. 2017 Dec;20(12):1237-1243
pubmed: 28777020
J Neurooncol. 2012 Feb;106(3):627-35
pubmed: 21881877
Med Care. 2016 Sep;54(9):e55-64
pubmed: 24638121
Eur J Cancer. 2012 Sep;48(14):2192-202
pubmed: 22608262
Cancer. 2017 Sep 1;123(17):3277-3284
pubmed: 28452053
Pharmacoeconomics. 2014 Dec;32(12):1201-12
pubmed: 25085219
Ann Neurol. 2008 Dec;64(6):628-34
pubmed: 19107984
Drugs Context. 2015 Mar 10;4:
pubmed: 25834620
J Clin Oncol. 2004 May 1;22(9):1583-8
pubmed: 15051755
Neuro Oncol. 2015 Oct;17 Suppl 4:iv1-iv62
pubmed: 26511214
N Engl J Med. 2005 Mar 10;352(10):987-96
pubmed: 15758009
Oncotarget. 2017 Jul 4;8(27):44015-44031
pubmed: 28467795
JAMA. 2005 Feb 2;293(5):557-64
pubmed: 15687310
J Oncol Pract. 2015 Jan;11(1):e59-65
pubmed: 25466707
N Engl J Med. 2014 Feb 20;370(8):709-22
pubmed: 24552318