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Treatment Patterns, Costs, and Survival among Medicare-Enrolled Elderly Patients Diagnosed with Advanced Stage Gastric Cancer: Analysis of a Linked Population-Based Cancer Registry and Administrative Claims Database.

Karve S, Lorenzo M, Liepa AM, Hess LM, Kaye JA, Calingaert B - J Gastric Cancer (2015)

Bottom Line: In total, 2,583 patients met the inclusion criteria.The mean age at index was 74.8±6.0 years.Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.

View Article: PubMed Central - PubMed

Affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.

ABSTRACT

Purpose: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy.

Materials and methods: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) ≥65 years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemo-therapy agent.

Results: In total, 2,583 patients met the inclusion criteria. The mean age at index was 74.8±6.0 years. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) 70,808±56,620. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001).

Conclusions: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival estimates. (A) Survival post gastric cancer diagnosis, by treatment Cohort. (B) Survival post completion of first-line chemotherapy, by treatment Cohort.
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Figure 1: Kaplan-Meier survival estimates. (A) Survival post gastric cancer diagnosis, by treatment Cohort. (B) Survival post completion of first-line chemotherapy, by treatment Cohort.

Mentions: A total of 2,583 patients were identified for analysis after applying all inclusion and exclusion criteria (Table 1). Of these, approximately 55% (n=1,415) received additional cancer-directed therapy after the completion/discontinuation of first-line chemotherapy, and they were classified as 'additionally treated.' The remaining 45% of patients (n=1,168) were classified as 'supportive care only.' The mean patient age at the index date was 74.8±6.0 years. Additionally treated patients were approximately 10 months younger than patients in the supportive care only group (74.4±6.0 years vs. 75.2±5.9 years; P<0.001). Over two-thirds of patients were male, and approximately 80% were white, a trend that remained consistent across the additionally treated and supportive care only groups. Cardia not otherwise specified (NOS) was the most commonly observed (43%) tumor location site, which differed between the additionally treated and supportive care only groups (50% vs. 35%; P<0.001). Slightly more than half (54%) of all patients presented with metastatic (distant) stage disease at the initial gastric cancer diagnosis. Ninety-two percent of patients died during the follow-up period (Fig. 1A). The median survival was 361 days for the post-gastric cancer diagnosis period, compared with 167 days following the completion of first-line chemotherapy. Median survival was longer (272 days) in the additionally treated group than in the supportive care only group (72 days) after the completion of first-line chemotherapy (Fig. 1B). Additional survival estimates are presented in Appendix 2.


Treatment Patterns, Costs, and Survival among Medicare-Enrolled Elderly Patients Diagnosed with Advanced Stage Gastric Cancer: Analysis of a Linked Population-Based Cancer Registry and Administrative Claims Database.

Karve S, Lorenzo M, Liepa AM, Hess LM, Kaye JA, Calingaert B - J Gastric Cancer (2015)

Kaplan-Meier survival estimates. (A) Survival post gastric cancer diagnosis, by treatment Cohort. (B) Survival post completion of first-line chemotherapy, by treatment Cohort.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496446&req=5

Figure 1: Kaplan-Meier survival estimates. (A) Survival post gastric cancer diagnosis, by treatment Cohort. (B) Survival post completion of first-line chemotherapy, by treatment Cohort.
Mentions: A total of 2,583 patients were identified for analysis after applying all inclusion and exclusion criteria (Table 1). Of these, approximately 55% (n=1,415) received additional cancer-directed therapy after the completion/discontinuation of first-line chemotherapy, and they were classified as 'additionally treated.' The remaining 45% of patients (n=1,168) were classified as 'supportive care only.' The mean patient age at the index date was 74.8±6.0 years. Additionally treated patients were approximately 10 months younger than patients in the supportive care only group (74.4±6.0 years vs. 75.2±5.9 years; P<0.001). Over two-thirds of patients were male, and approximately 80% were white, a trend that remained consistent across the additionally treated and supportive care only groups. Cardia not otherwise specified (NOS) was the most commonly observed (43%) tumor location site, which differed between the additionally treated and supportive care only groups (50% vs. 35%; P<0.001). Slightly more than half (54%) of all patients presented with metastatic (distant) stage disease at the initial gastric cancer diagnosis. Ninety-two percent of patients died during the follow-up period (Fig. 1A). The median survival was 361 days for the post-gastric cancer diagnosis period, compared with 167 days following the completion of first-line chemotherapy. Median survival was longer (272 days) in the additionally treated group than in the supportive care only group (72 days) after the completion of first-line chemotherapy (Fig. 1B). Additional survival estimates are presented in Appendix 2.

Bottom Line: In total, 2,583 patients met the inclusion criteria.The mean age at index was 74.8±6.0 years.Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.

View Article: PubMed Central - PubMed

Affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.

ABSTRACT

Purpose: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy.

Materials and methods: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) ≥65 years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemo-therapy agent.

Results: In total, 2,583 patients met the inclusion criteria. The mean age at index was 74.8±6.0 years. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) 70,808±56,620. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001).

Conclusions: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.

No MeSH data available.


Related in: MedlinePlus