Lung cancer costs by treatment strategy and phase of care among patients enrolled in Medicare

Sheehan, Deirdre F.; Criss, Steven D.; Chen, Yufan; Eckel, Andrew; Palazzo, Lauren; Tramontano, Angela C.; Hur, Chin; Cipriano, Lauren E.; Kong, Chung Yin

doi:10.1002/cam4.1896

Cited by 58 publications

(61 citation statements)

References 17 publications

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“…While phase‐specific costs have been published for several cancer sites, we found a lack of cost estimates with this level of detail for esophageal cancer in the US One phase‐specific cost study by Kaye (2018) included esophageal cancer as one of 10 different cancers . The Kaye study estimated a mean annual total cost of $20 433 (mean $1703/month) for the initial phase and $18 760 (mean $1563/month) for the terminal phase.…”

Section: Discussionmentioning

confidence: 95%

“…We allocated each patient's costs into four separate phases of care—staging (or surgery), initial, continuing, and terminal, defined in terms of months, where “month” refers to a unit of 30 days, regardless of where it falls on the calendar …”

Section: Methodsmentioning

confidence: 99%

“…After the staging or surgery phase, patients had a 6‐month initial phase, followed by a continuing phase varying in length between patients depending on survival time. Those patients who died on or before December 31, 2013 had a 6‐month terminal phase ending on the date of death . Those who survived past 2013 were not considered to have a terminal phase.…”

Section: Methodsmentioning

confidence: 99%

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Esophageal cancer treatment costs by phase of care and treatment modality, 2000‐2013

et al. 2019

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Background Detailed cost estimates are not widely available for esophageal cancer. Our study estimates phase‐specific costs for esophageal cancer by age, year, histology, stage, and treatment for older patients in the United States and compares these costs within stage and treatment modalities. Methods We identified 8061 esophageal cancer patients in the Surveillance, Epidemiology, and End Results‐Medicare database for years 1998‐2013. Total, cancer‐attributable, and patient‐liability costs were calculated based on separate phases of care—staging (or surgery), initial, continuing, and terminal. We estimated costs by treatment modality within stage and phase for esophageal adenocarcinoma and squamous cell carcinoma separately. We fit linear regression models using log transformation to determine cost by age and calendar year. All costs are reported in 2018 US dollars. Results Overall, mean (95% CI) monthly total cost estimates were high during the staging ($8953 [$8385‐$9485]) and initial phases ($7731 [$7492‐$7970]), decreased over the continuing phase ($2984 [$2814‐$3154]), and increased substantially during the 6‐month terminal phase ($18 150 [$17 211‐$19 089]). This pattern of high staging and initial phase costs, decreasing continuing phase costs, and increasing terminal phase costs was seen in all stages. The highest staging costs were in stages III ($9249, $8025‐$10 474) and II ($9171, $7642‐$10 699). The highest initial phase cost was in stage IV, $9263 ($8758‐49 768), the lowest continuing phase cost was in stage I, $2338 ($2160‐$2517), and the highest terminal phase costs were in stages II ($20 533, $17 772‐$23 293) and III ($20 599, $18 268‐$22 929). The linear regression models showed that cancer‐attributable costs remained stable over the study period and were unaffected by age for most histology, stage, and treatment modality subgroups. Conclusions Our estimates demonstrate that esophageal cancer costs can vary widely by histology, stage, and treatment. These cost estimates can be used to guide future resource allocation for esophageal cancer care and research.

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Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Esophageal cancer treatment costs by phase of care and treatment modality, 2000‐2013

et al. 2019

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“…Patient liability costs represented 14%‐16% of these costs. In the study of the SEER‐Medicare database for years 1998‐2013, total monthly costs of the initial phase of chemotherapy for a representative 70‐year‐old patient with extensive‐stage SCLC were $6713 (in 2017 USD) …”

Section: Discussionmentioning

confidence: 99%

Chemotherapy treatments, costs of care, and survival for patients diagnosed with small cell lung cancer: A SEER‐Medicare study

et al. 2019

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Objectives The effectiveness and costs of new treatments should be assessed in relation to existing practice. We describe treatments, survival and costs for advanced or metastatic small cell lung cancer (SCLC) patients receiving systemic therapy in the period preceding the introduction of immunotherapies. Materials and Methods This was a retrospective cohort study of patients aged ≥65 years, identified using linked Surveillance, Epidemiology, and End Results and Medicare databases. Individuals with a new primary diagnosis of SCLC between January 2007 and December 2013 were followed until December 2014. Chemotherapy treatments, health care visits and costs (in 2016 USD), and survival were determined by line of therapy. Results A total of 11 812 patients were identified with SCLC. First‐line (1L) chemotherapy was received by 6509 (55.1%) patients, most (93.2%) with carboplatin‐ (71.0%) or cisplatin‐ (22.2%) based therapies, typically combined with etoposide (79.2%). Second‐ (2L) and third‐ (3L) line chemotherapies were received by 2238 (18.9%) and 679 (5.7%) patients, of which 48.4% and 30.9%, respectively, were platinum‐based. The median durations of 1L, 2L, and 3L carboplatin‐based therapies were 5.9, 4.8, and 5.4 months, respectively, and the corresponding durations of cisplatin‐based therapies were 5.3, 4.2, and 5.3 months. During 1L, 2L, and 3L chemotherapies, patients averaged 8.2, 7.4, and 7.3 health care visits per month, respectively, and incurred total mean health care costs of $60 223, $42 636, and $35 903 per patient, respectively. Median survival from the start of 1L, 2L, and 3L chemotherapy was 9.2, 6.0, and 5.7 months, respectively. Conclusion First‐line chemotherapy was primarily platinum‐based, and a plethora of different regimens was used for 2L and 3L chemotherapies. Median survival from the start of 1L chemotherapy was 9 months, with an associated health care cost of $60 000. These data highlight an unmet medical need among SCLC patients receiving systemic therapy.

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“…Lung cancer is associated with high morbidity, mortality, and cost of care, and it is the second most common cancer by incidence in the United States 1 . In 2020, the estimated number of new cases of lung cancer in the US alone, will be 228,820 (116300 in men and 112520 in women) and the number of deaths is projected to be 135,720 (72,500 in men and 63, 220 in women) 2 .…”

Section: Introductionmentioning

confidence: 99%

Image‐guided video‐assisted thoracoscopic resection (iVATS): Translation to clinical practice—real‐world experience

Gill

Barlow

Jaklitsch

et al. 2020

Journal of Surgical Oncology

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Objective: We developed a novel approach for localization and resection of lung nodules, using image-guided video-assisted thoracoscopic surgery (iVATS). We report our experience of translating iVATS into clinical care.Methods: Methodology and workflow for iVATS developed as part of the Phase I/II trial were used to train surgeons, radiologists, anesthesiologists, and radiology technologists. Radiation dose, time from induction to incision, placement of T-bar to incision and incision to closure, hospital stay, and complication rates were recorded.Results: Fifty patients underwent iVATS for resection of 54 nodules in a clinical hybrid operating room (OR) by six surgeons. Fifty-two (97%) nodules were successfully resected.Forty-two (84%) patients underwent wedge resection, four (7%) lobectomies, and two (4%) segmentectomy all with lymph node dissection. Median time from induction to incision was 89 minutes (range: 13-256 minutes); T-bar placement was 14 minutes (10-29 minutes); and incision to closure, 107 minutes (41-302 minutes). Average and total procedure radiation dose were: median = 6 mSieverts (range: 2.9-35 mSieverts). No deaths were reported and median length of stay was 3 days (range: 1-12 days).Conclusions: Translation of iVATS into clinical practice has been initiated using a safe step-wise process, combining intraoperative C-arm computed tomography scanning and thoracoscopic surgery in a hybrid OR. K E Y W O R D Sadvanced image-guided operating room, C-arm CT, fiducials, hybrid operating room, lung cancer, VATS

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Lung cancer costs by treatment strategy and phase of care among patients enrolled in Medicare

Cited by 58 publications

References 17 publications

Esophageal cancer treatment costs by phase of care and treatment modality, 2000‐2013

Esophageal cancer treatment costs by phase of care and treatment modality, 2000‐2013

Chemotherapy treatments, costs of care, and survival for patients diagnosed with small cell lung cancer: A SEER‐Medicare study

Image‐guided video‐assisted thoracoscopic resection (iVATS): Translation to clinical practice—real‐world experience

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