P-0069 - Costs and patterns of gastric cancer care in the US: A retrospective analysis of administrative claims data
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Gastric Cancer
Bioethics, Legal, and Economic Issues
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
L. Hess, D. Mytelka, J. Beyrer, S. Nicol
The cost of cancer is a concern for patients, providers and for society. Some cancers, such as gastric cancer, are associated with poor survival and have received little attention in the outcomes research field. As a result, little is known about costs or treatment patterns. To address this gap in knowledge, this study was designed to describe the treatment patterns and costs from US claims data to inform health outcomes research studies in gastric cancer.
This retrospective cohort study utilized data from the Truven Health MarketScan® Research database, a HIPAA-compliant, patient-level database containing inpatient, outpatient, drug, and laboratory data from commercial and Medicare supplemental adjudicated claims. Claims data from 1/1/2004 through 3/31/2013 were used in this study. Patients age ≥18 with a new diagnosis of gastric cancer (ICD-9-CM 151.0-151.9) between July 1, 2004 and March 31, 2012 (index diagnosis) were eligible if they had both continuous medical benefits and no evidence of cancer within six months prior to the index diagnosis without gastrointestinal stromal tumor (ICD-9-CM 238.1) at any time. Healthcare Common Procedure Coding System (HCPCS), National Drug Codes (NDC) and Current Procedural Terminology (CPT) codes were used to identify chemotherapy, radiation therapy, surgical procedures and other supportive care medications used. Costs were obtained from third-party payments and adjusted for inflation to 2012 dollars.
Following application of the eligibility criteria, 11,891 patients with gastric cancer were identified. The mean (standard deviation) age was 65.0 (13.9) and majority was male (62.5%). Of the 5,298 patients with chemotherapy treatment data, the most common first-line regimens included platinum + fluoropyrimidine combined with one or more other agents (e.g. docetaxel, epirubicin, gemcitabine) (24.0%), only a fluoropyrimidine (23.8%), a platinum with other agents (19.8%), or doublet platinum + fluoropyrimidine (15.9%), and 11.6% received a regimen that contained neither a fluoropyrimidine nor platinum. However, there was more variation among the 2,886 receiving second-line treatment: 25.1% received only fluoropyrimidine therapy; 18% received regimens with other non-fluoropyrimidine/non-platinum agents; 10.8% received platinum with a fluoropyrimidine, 18.2% received platinum with other agents, 17.4% received platinum + fluoropyrimidine combined with other agents, and only 4.2% received single-agent platinum. The mean per patient all-cause third party payments during first-line therapy were $40,805 (standard deviation (SD) = $49,914), which were incurred over an average of 53.5 days. A similar pattern was evident in second line (mean/sd: $26,580/$33,298) over a mean of 41.2 days of treatment. Cost data were highly variable and right skewed. The largest portion of these costs was from institutional claims (average/SD costs of $26,128/$47,910 and $17,958/$29,163 for first and second line therapy, respectively).
There is considerable variability in the costs, therapeutic regimens and duration of care received among gastric cancer patients in the US. While most patients received first-line treatment containing a fluoropyrimidine and/or a platinum agent, the regimens used were highly variable. In the second line, this variability was more pronounced with more agents from different classes being used in this setting. There is a need to identify more standardized approaches for care that are associated with improved gastric cancer outcomes.