The Cost of Treatment of Skeletal-Related Events in Patients with Bone Metastases from Lung Cancer

Abstract

Purpose: Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) including pathological fracture, spinal cord compression, hypercalcemia or pain requiring surgery, radiotherapy or opioid analgesics. These complications result in impaired mobility and reduced quality of life and have a significant negative impact on survival. The economic consequences of SREs in patients with lung cancer have not been examined. Methods: We conducted a retrospective analysis using a large US health insurance claims database to estimate the incidence and costs of treatment of SREs in patients with bone metastases of lung cancer treated in a naturalistic setting. Study subjects had ≧2 encounters with a diagnosis of primary lung cancer and ≧2 encounters with a diagnosis of metastases to bone. SREs were identified based on the occurrence on or after the date of first diagnosis of bone metastases, of (1) ≧1 encounter with a diagnosis of pathological fracture, spinal cord compression or hypercalcemia, (2) ≧1 bone surgery or radiotherapy procedure, or (3) the initiation of opioid analgesic therapy. Survival and costs of SRE-related care in patients with SREs were estimated using Kaplan-Meier methods. Results: We identified 534 patients with lung cancer and bone metastases, including 295 (55%) with ≧1 SRE. Radiotherapy (68%) and fracture (35%) were the most common SREs. Median survival after the first identified SRE was 4.1 months (95% confidence interval: 3.6–5.5 months). The estimated lifetime SRE-related cost per patient was USD 11,979 (95% confidence interval: USD 10,193–13,766). Radiotherapy accounted for the greatest proportion of cost (61%) by SRE type. Conclusion: The economic burden of SREs in patients with bone metastases of lung cancer is substantial. Intravenous bisphosphonates, such as zoledronic acid, which have been shown to prevent these events, may reduce these costs.

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

“…There are several articles that have examined the health care utilization and cost associated with the management of general bony metastasis and its associated "skeletal events," with some providing a subanalysis of spinal column metastasis. 8,13,14,17 These studies contain a heterogeneous cohort of patients, but offer a valuable sense of the expense associated with the management of bony metastasis. The average cost of treating a skeletal event secondary to metastasis is reported to range from $10,000 to $12,000.…”

“…The average cost of treating a skeletal event secondary to metastasis is reported to range from $10,000 to $12,000. 14,22 This seems to be a relatively low cost; however, the reported means include both medical and surgical management modalities (with surgery making up a very small proportion of cases). Therefore, the extrapolation of the actual cost of surgery among these studies is difficult and limited.…”

“…There is a paucity of studies that directly evaluate the cost of surgery for spinal tumors. 9,12,34,41,44 Many of the past studies have focused on the health care costs associated with managing (medically and/or surgically) heterogeneous cohorts of patients with bony metastasis 8,13,14,17 or evaluated the cost effectiveness of adjuvant radiotherapy for spinal metastasis. 15 In addition, among those studies there is a lack of details regarding the type of procedure performed or a dedicated analysis of the factors that affect cost.…”

Health resource utilisation associated with skeletal-related events in European patients with lung cancer: Α subgroup analysis from a prospective multinational study

“…In addition to the clinical and patient impact, SREs place a considerable burden onto healthcare systems. Several retrospective studies have highlighted the increase in treatment costs as patients with lung cancer progress to metastatic bone disease and experience associated SREs (14)(15)(16)(17)(18). A prospective study in France also highlighted the high cost of care of patients with SREs, with 50% of the cost for the treatment of patients with lung cancer who have bone metastases being linked to the occurrence of SREs (19).…”

Physician Preferences for Bone Metastasis Drug Therapy in Canada

“…Bone metastases often lead patients to experience bone complications-a lso k now n as skeletal-related events (sres)-that include pathologic fractures, spinal cord compression, and a need for surgery or radiation to bone 4,5 . In more than half these patients, bone complications can result in severe pain 6 , impaired mobility, increased morbidity and mortality, reduced health-related quality of life 2,7,8 , and increased health care costs 9,10 .…”