Resource Utilization in Patients with Brain Metastases Managed with Best Supportive Care, Radiotherapy and/or Surgical Resection: A Markov Analysis

Abstract

Objective: In spite of the large number of patients and increasing financial pressure on health care budgets worldwide, limited data on resource utilization after diagnosis of brain metastases are available. Methods: Prospective data were collected on all patients diagnosed with brain metastases during a time period of 2 years (n = 53). Treatment was best supportive care (BSC), primary radiotherapy (RT) and/or surgical resection. Eighty-five percent of patients had active extracranial disease. Costs were calculated from the hospital and nursing home’s point of view. Results: Overall, 11,532 patient days were analyzed. Treatment per patient amounted to 0.8 courses of whole-brain RT, 0.2 neurosurgical procedures, 0.1 radiosurgical procedures and 1.3 cycles of chemotherapy. Median survival in the BSC, RT and neurosurgery groups was 1.4, 4.6 and 11.0 months, respectively. Chemotherapy was associated with longer median survival. Four percent of the remaining lifetime was spent in nursing homes and 8% within hospitals. Forty-three percent of all hospital days and 47% of deaths were related to non-neurologic causes. The total cost per patient was 24,649 EUR (34,841 USD) and the corresponding cost per life year was 43,955 EUR (62,130 USD). Hospital care was the main cost factor. Conclusions: A considerable amount of resources is utilized in this patient group. Better tools for avoiding overtreatment and selecting patients for appropriate therapy are needed to achieve maximum value for money.

Presentation, patterns of care, and survival in patients with brain metastases

“…Several authors reported median survival of 1.3 months to 2.1 months in patients managed with best supportive care without radiotherapy. 3,15,23 The current survival data in RPA class III and the most unfavorable GPA class (0-1 point; Table 3) are in the same range. Therefore, prospective comparison of best supportive care versus cranial radiotherapy in patients with limited prognosis is justified.…”

“…Of course, increases in SRS and chemotherapy utilization as well as introduction of new classes of drugs will lead to increased cost. In our recent analysis, we found this cost to be €43,955 per life year for the average patient with brain metastases, 3 and this does not exceed treatment costs in comparable oncologic scenarios. It is also noteworthy that better individualization of treatment in some cases might save resources as emphasized by the increasing use of short-course WBRT.…”

Brain metastases in patients with ALK+ non-small cell lung cancer: clinical symptoms, treatment patterns and economic burden

“…Brain metastases are known to severely impact a patient's quality-of-life (physical, cognitive, and functional impairments) 24,31,33 , as well as to result in high healthcare resource utilization 37 and substantial clinical 43 , economic 27 , and caregiver 32 burden. In this study, we found that the development of brain metastases is associated with a substantial treatment burden, resource use, and costs in ALKþ NSCLC patients (identified by the use of crizotinib).…”

“…A probable explanation for the differences in cost distribution is that using targeted agents for the treatment of (brain) metastatic ALKþ NSCLC increases pharmacy costs, but reduces the use of inpatient services, possibly indicating that the disease has been managed (for a period of time). Another study evaluating the costs of treating brain-metastatic cancer patients (of which 55% were lung cancer patients) also found that brain metastases are associated with a significant economic burden, concluding that the total costs per year of life amounted to $62,130 (where less than 25% of the patients survived the first year of treatment) 37 . This study has demonstrated that the development of brain metastases, common in ALKþ NSCLC, can be costly and can present a substantial clinical burden.…”

“…Thus, disease management and treatment planning for patients with brain metastases typically requires a multi-disciplinary approach and highly specialized care [34][35][36] , and involves a substantial caregiver 32 and economic 27 burden. Few studies have characterized the clinical and economic burden experienced by patients with brain metastases 27,37,38 , and none has specifically analyzed the (ALKþ) NSCLC population. The objective of this study is to evaluate the impact of developing brain metastases on patients with ALKþ NSCLC in terms of economic and clinical outcomes.…”