Health care resource use among patients with advanced non-small cell lung cancer: the PIvOTAL retrospective observational study

Abstract

BackgroundData are scarce regarding real-world health care resource use (HCRU) for non-small cell lung cancer (NSCLC). An understanding of current clinical practices and HCRU is needed to provide a benchmark for rapidly evolving NSCLC management recommendations and therapeutic options. The objective of this study was to describe real-world HCRU for patients with advanced NSCLC.MethodsThis multinational, retrospective chart review study was conducted at academic and community oncology sites in Italy, Spain, Germany, Australia, Japan, South Korea, Taiwan, and Brazil. Deidentified data were drawn from medical records of 1440 adults (≥18 years old) who initiated systemic therapy (2011 to mid-2013) for a new, confirmed diagnosis of advanced or metastatic (stage IIIB or IV) NSCLC. We summarized HCRU associated with first and subsequent lines of systemic therapy for advanced/metastatic NSCLC.ResultsThe proportion of patients who were hospitalized at least once varied by country from 24% in Italy to 81% in Japan during first-line therapy and from 22% in Italy to 84% in Japan during second-line therapy; overall hospitalization frequency was 2.5–11.1 per 100 patient-weeks, depending on country. Emergency visit frequency also varied among countries (overall from 0.3–5.9 per 100 patient-weeks), increasing consistently from first- through third-line therapy in each country. The outpatient setting was the most common setting of resource use. Most patients in the study had multiple outpatient visits in association with each line of therapy (overall from 21.1 to 59.0 outpatient visits per 100 patient-weeks, depending on country). The use of health care resources showed no regular pattern associated with results of tests for activating mutations of the epidermal growth factor receptor (EGFR) gene or anaplastic lymphoma kinase (ALK) gene rearrangements.ConclusionsHCRU varied across countries. These findings suggest differing approaches to the clinical management of advanced NSCLC among the eight countries. Comparative findings and an understanding of country-specific clinical practices can help to identify areas of need and guide future resource allocation for patients with advanced NSCLC. Further studies evaluating the costs associated with resource use are warranted.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2946-8) contains supplementary material, which is available to authorized users.

Molecular testing and treatment patterns for patients with advanced non-small cell lung cancer: PIvOTAL observational study

“…In the other countries, informed consent was not required for working with the de-identified retrospective data used in the study. Full details of ethical approvals have been published [ 35 ] and the names of the institutional review boards / independent ethics committees for each study site are provided in Supporting S1 Table . All data in the patient records used in this retrospective study were fully deidentified / anonymized before any of the study authors accessed them.…”

“…Our focus was on molecular testing for two predictive biomarkers, EGFR mutation and ALK rearrangement, for which targeted therapies were approved and available during the study years. The overall treatment pattern and health care resource use data from the study have been published [ 33 – 35 ].…”

Initial Experience after Transition to Immune Checkpoint Inhibitors in Patients with Non-small Cell Lung Cancer Treated in a Rural Healthcare Region

“…However, real-world data from elderly rural patient cohorts might differ from those obtained in clinical trials. It is therefore necessary to perform additional and larger studies about the ICIrelated patterns of terminal care, taking into account the fact that resource use varies between countries [18].…”

Advanced-Metastatic Non-Small-Cell Lung Cancer EGFR-mutated in Italy: patient management costs and potential productivity losses

“…I costi relativi alle ospedalizzazioni dovute a una acutizzazione della patologia sono stati calcolati come prodotto tra i giorni medi di degenza nella tipologia di pazienti in esame per linea di terapia, derivanti da letteratura 15 e dalla pratica clinica, e il DRG giornaliero medio per il ricovero ospedaliero a causa di neoplasie respiratorie, 16 dato dal rapporto tra il totale della spesa annua dei ricoveri in regime ordinario e il numero totale annuo di giorni di ricoveri per la specifica patologia (Tabella Supplementare 3). Considerando che il sistema di rimborso dei ricoveri ospedalieri è basato su DRG fissi, il calcolo è stato effettuato con questa metodologia per valorizzare le differenze di costo tra le varie linee di trattamento.…”

“…Non si evincono differenze di costo tra osimertinib e i TKI standard per quanto riguarda le ospedalizzazioni: ciò è dovuto al fatto che, al meglio della nostra conoscenza, i dati di letteratura 15 relativi alla degenza ospedaliera in questa tipologia di pazienti sono aggregati per linea di terapia e non fanno distinzione per tipologia di trattamento.…”