J Gastric Cancer.  2015 Jun;15(2):87-104. 10.5230/jgc.2015.15.2.87.

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

• KMID: 2372356
• DOI: http://doi.org/10.5230/jgc.2015.15.2.87

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) > or =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.

Keyword

Gastric cancer; Treatment patterns; Costs; Survival; Claims data

MeSH Terms

Aged*
Delivery of Health Care
Diagnosis
Drug Therapy
Epidemiology
Follow-Up Studies
Humans
Incidence
Medicare
Medicare Part A
Platinum
Retrospective Studies
Stomach Neoplasms*
United States
Platinum

Figure

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  Fig. 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.

Reference

1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014; 64:9–29.

2. Howlader N, Noone AM, Krapcho M, Garshell J, Neyman N, Altekruse SF, et al. National Cancer Institute. SEER Cancer Statistics Review, 1975-2010 [Internet]. Bethesda (MD): National Cancer Institute;cited 2013 Apr. Available from: http://seer.cancer.gov/archive/csr/1975_2010/.

3. Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev. 2014; 23:700–713.

4. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Gastric Cancer. Version 1. [Internet]. 2014. Fort Washington(PA): NCCN;cited 2014 Jul 23. Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

5. Ajani JA. Evolving chemotherapy for advanced gastric cancer. Oncologist. 2005; 10:Suppl 3. 49–58.

6. National Cancer Institute. The Surveillance, Epidemiology, and End Results: Population Characteristics. [Internet]. Bethesda (MD): National Cancer Institute;2013. cited 2013 Dec 31. Available from: http://seer.cancer.gov/registries/characteristics.html.

7. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002; 40:8 Suppl. IV-3–IV-18.

8. Warren JL, Harlan LC, Fahey A, Virnig BA, Freeman JL, Klabunde CN, et al. Utility of the SEER-Medicare data to identify chemotherapy use. Med Care. 2002; 40:8 Suppl. IV-55–IV-61.

9. Brown ML, Riley GF, Schussler N, Etzioni R. Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care. 2002; 40:8 Suppl. IV-104–IV-117.

10. Cooper GS, Virnig B, Klabunde CN, Schussler N, Freeman J, Warren JL. Use of SEER-Medicare data for measuring cancer surgery. Med Care. 2002; 40:8 Suppl. IV-43–IV-48.

11. Virnig BA, Warren JL, Cooper GS, Klabunde CN, Schussler N, Freeman J. Studying radiation therapy using SEER-Medicare-linked data. Med Care. 2002; 40:8 Suppl. IV-49–IV-54.

12. Sundararajan V, Hershman D, Grann VR, Jacobson JS, Neugut AI. Variations in the use of chemotherapy for elderly patients with advanced ovarian cancer: a population-based study. J Clin Oncol. 2002; 20:173–178.

13. Hershman D, Hall MJ, Wang X, Jacobson JS, McBride R, Grann VR, et al. Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer. Cancer. 2006; 107:2581–2588.

14. Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008; 61:1234–1240.

15. Lang K, Marciniak MD, Faries D, Stokes M, Buesching D, Earle C, et al. Costs of first-line doublet chemotherapy and lifetime medical care in advanced non-small-cell lung cancer in the United States. Value Health. 2009; 12:481–488.

16. Ramsey SD, Howlader N, Etzioni RD, Donato B. Chemotherapy use, outcomes, and costs for older persons with advanced non-small-cell lung cancer: evidence from surveillance, epidemiology and end results-Medicare. J Clin Oncol. 2004; 22:4971–4978.

17. Ramsey SD, Martins RG, Blough DK, Tock LS, Lubeck D, Reyes CM. Second-line and third-line chemotherapy for lung cancer: use and cost. Am J Manag Care. 2008; 14:297–306.

18. Pasini F, Fraccon AP, DE Manzoni G. The role of chemotherapy in metastatic gastric cancer. Anticancer Res. 2011; 31:3543–3554.

19. Javle M, Hsueh CT. Updates in gastrointestinal oncology: insights from the 2008 44th annual meeting of the American Society of Clinical Oncology. J Hematol Oncol. 2009; 2:9.

20. Kilickap S, Yalcin S, Ates O, Tekuzman G. The first line systemic chemotherapy in metastatic gastric carcinoma: A comparison of docetaxel, cisplatin and fluorouracil (DCF) versus cisplatin and fluorouracil (CF); versus epirubicin, cisplatin and fluorouracil (ECF) regimens in clinical setting. Hepatogastroenterology. 2011; 58:208–212.

21. Van Cutsem E. The treatment of advanced gastric cancer: new findings on the activity of the taxanes. Oncologist. 2004; 9:Suppl 2. 9–15.

22. Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, et al. V325 Study Group. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol. 2006; 24:4991–4997.

23. Hironaka S, Zenda S, Boku N, Fukutomi A, Yoshino T, Onozawa Y. Weekly paclitaxel as second-line chemotherapy for advanced or recurrent gastric cancer. Gastric Cancer. 2006; 9:14–18.

24. Jo JC, Lee JL, Ryu MH, Sym SJ, Lee SS, Chang HM, et al. Docetaxel monotherapy as a second-line treatment after failure of fluoropyrimidine and platinum in advanced gastric cancer: experience of 154 patients with prognostic factor analysis. Jpn J Clin Oncol. 2007; 37:936–941.

25. Kim HS, Kim HJ, Kim SY, Kim TY, Lee KW, Baek SK, et al. Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: a meta-analysis. Ann Oncol. 2013; 24:2850–2854.

26. Lee JL, Ryu MH, Chang HM, Kim TW, Yook JH, Oh ST, et al. A phase II study of docetaxel as salvage chemotherapy in advanced gastric cancer after failure of fluoropyrimidine and platinum combination chemotherapy. Cancer Chemother Pharmacol. 2008; 61:631–637.

27. Park SH, Kang WK, Lee HR, Park J, Lee KE, Lee SH, et al. Docetaxel plus cisplatin as second-line therapy in metastatic or recurrent advanced gastric cancer progressing on 5-fluorouracil-based regimen. Am J Clin Oncol. 2004; 27:477–480.

28. Thuss-Patience PC, Kretzschmar A, Bichev D, Deist T, Hinke A, Breithaupt K, et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer: a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer. 2011; 47:2306–2314.

29. Rosati G, Ferrara D, Manzione L. New perspectives in the treatment of advanced or metastatic gastric cancer. World J Gastroenterol. 2009; 15:2689–2692.

30. Kang JH, Lee SI, Lim do H, Park KW, Oh SY, Kwon HC, et al. Salvage chemotherapy for pretreated gastric cancer: a randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol. 2012; 30:1513–1518.

31. Bachmann M, Peters T, Harvey I. Costs and concentration of cancer care: evidence for pancreatic, oesophageal and gastric cancers in National Health Service hospitals. J Health Serv Res Policy. 2003; 8:75–82.

32. Elixhauser A, Halpern MT. Economic evaluations of gastric and pancreatic cancer. Hepatogastroenterology. 1999; 46:1206–1213.

33. Yabroff KR, Davis WW, Lamont EB, Fahey A, Topor M, Brown ML, et al. Patient time costs associated with cancer care. J Natl Cancer Inst. 2007; 99:14–23.

34. Sherman KL, Merkow RP, Shah AM, Wang CE, Bilimoria KY, Bentrem DJ. Assessment of advanced gastric cancer management in the United States. Ann Surg Oncol. 2013; 20:2124–2131.

35. Kalinka-Warzocha E, Plazas JG, Mineur L, Salek T, Hendlisz A, DeCosta L, et al. Chemotherapy treatment patterns and neutropenia management in gastric cancer. Gastric Cancer. 2015; 18:360–367.