Abstract
BackgroundThis study analyzes the impact of skeletal-related events (SRE) on healthcare resource utilization (HCRU) and costs incurred by patients with bone metastases (BM) from solid tumors (ST), who are therapy-naïve to bone targeting agents (BTAs).MethodsGerman claims data from 01/01/2010 to 30/06/2018 were used to conduct a retrospective comparative cohort analysis of BTA-naive patients with a BM diagnosis and preceding ST diagnosis. HCRU and treatment-related costs were compared in two matched cohorts of patients with and without a history of SREs, defined as pathological fracture, spinal cord compression, surgery to bone and radiation to bone. The first SRE was defined as the patient-individual index date. Conversely, for the non-SRE patients, index dates were assigned randomly.ResultsIn total, 45.20% of 9,832 patients reported experiencing at least one SRE (n = 4444) while 54.80% experienced none (n = 5388); 2,434 pairs of SRE and non-SRE patients were finally matched (mean age: 70.87/71.07 years; females: 39.07%/38.58%). Between SRE and non-SRE cohorts, significant differences in the average number of hospitalization days per patient-year (35.80/30.80) and associated inpatient-care costs (14,199.27€/10,787.31€) were observed. The total cost ratio was 1.16 (p < 0.001) with an average cost breakdown of 23,689.54€ and 20,403.27€ per patient-year in SRE and non-SRE patients.ConclusionThe underutilization of BTAs within a clinical setting poses an ongoing challenge in the real-world treatment of BM patients throughout Germany. Ultimately, the economic burden of treating SREs in patients with BM from ST was found to be considerable, resulting in higher direct healthcare costs and increased utilization of inpatient care facilities.
Highlights
Bone is a very common site for cancer metastases from solid tumors [1, 2]
bone metastases (BM) can result in serious skeletal complications, known as skeletal-related events (SRE) which are commonly defined as pathologic fractures, radiation or surgery to the bone and spinal cord compression [4, 5]
While the general burden of SREs has been assessed for different European countries and previous research on the cost-effectiveness of denosumab has been performed [15], healthcare resource utilization (HCRU) and costs associated with SREs in patients untreated with bone targeting agents (BTAs) are not known so far
Summary
Bone is a very common site for cancer metastases from solid tumors [1, 2]. a multitude of malignancies can cause bone metastases (BM), BM are most prevalent in breast and prostate cancers (65–75%) as well as lung cancer (30–40%) [2,3,4]. Despite the existing evidence that treatment with either IVBPs or denosumab can delay the occurrence of SREs, prompt and sufficient pharmaceutical management is not necessarily present in clinical practice [2, 7] Such undertreatment may lead to a substantial patient burden as well as a high healthcare resource utilization (HCRU) and cost [7,8,9,10,11,12,13,14]. This study analyzes the impact of skeletal-related events (SRE) on healthcare resource utilization (HCRU) and costs incurred by patients with bone metastases (BM) from solid tumors (ST), who are therapy-naïve to bone targeting agents (BTAs). The economic burden of treating SREs in patients with BM from ST was found to be considerable, resulting in higher direct healthcare costs and increased utilization of inpatient care facilities
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