A14 - Economic burden of patients with Malignant Pleural Mesothelioma in a high prevalence center

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Background: The current economic constraints push hospital management in using rationally the available public resources. This is even more relevant in patients with Malignant Pleural Mesothelioma (MPM) given the severity of the disease, its dismal prognosis and the cost of chemotherapy drugs. This work aims at evaluating the standard reimbursement of patients with MPM, supporting physicians in their decision making process with respect the budget constraint. Patients and methods: We conducted a retrospective cost analysis, including all the patients with MPM undergoing their first medical examination in our Hospital between 2014 and 2015. Exclusion criteria were only non-epithelioid istotype. We collected data about the diagnostic pathway and active treatments, as well as the relative official fees of each procedure. Afterwards, using a Regression based Cost Approach (RCA), we estimated the overall expected reimbursement of a patient with MPM treated in our hospital, which would be supported by Piedmont Region. Results: From 01/01/2014 to 31/12/2015, 102 patients with epithelioid MPM had a first medical examination in our hospital; 40 died before the end of data collection and constitute our selected sample. According to the RCA model, the reimbursed fees would be equal to a fixed cost of € 1,873.49 (p-value < 0.1) plus a variable cost of € 1,650.00 (p-value < 0.01) for every chemotherapy cycle, and a cost of € 2,932.52 (p-value < 0.05) in case of any hospitalization. The costs of the pathway are reduced of € 8,734.20 (p-value < 0.01) in case of enrollment in an experimental trial of first line treatment and of another € 6,399.04 (p-value < 0.01) in case of enrollment in a trial of second line treatment. Therefore, assuming a typical patient treated with 12 chemotherapy courses in the current clinical practice (i.e. no trial) and without hospitalization, we can expect a total cost of € 21,743.98, which would decrease to € 6,610.74 if the patient is enrolled in both trials. The RCA model has a R-square of 0.92 and is statistically significant (F-test). Conclusions: Our analysis suggest that the reimbursed impact of MPM is high and related mostly with active treatments and hospitalizations. These data, however, do not take into account the real costs of the clinical pathway. The economic gap between the reimbursement and the actual supported cost is probably significant and will be the object of further analysis. Clinical trials have a strong impact in cost containment.