Abstract
To date, there are no studies on healthcare resource utilization (HRU) and costs for treating periocular basal cell carcinoma (pBCC). We investigated real-world HRU and costs of patients with limited versus extensive pBCC. This was a retrospective cost analysis. Administrative claims database was mined for basal cell carcinoma (BCC)-related claims from January 2011 to December 2018. Patients had ≥1 inpatient or ≥2 outpatient nondiagnostic claims for pBCC ≥30 days apart, ≥6 months of continuous enrollment in a health plan before the index date, and ≥18 months of continuous enrollment after the index date. Patients were categorized by disease severity (limited or extensive) using Current Procedural Terminology codes. A total of 1368 patients were propensity matched 1:1 for limited and extensive pBCC (n=684 each). Outcomes were cost and HRU measures during the 18-month follow-up period. Patients with extensive disease had a higher number of outpatient visits (32.47 vs 28.81; P < .0001), radiation therapies (0.53 vs 0.17; P=.001), surgeries (1.82 vs 1.24; P < .001), days between first and last surgery (40.82 vs 16.51 days; P < .001), outpatient pBCC claims (3.89 vs 3.38; P < .001), and days between pBCC claims (170.43 vs 144.01 days; P < .001). Patients with extensive disease incurred higher total all-cause costs ($36,986.10 vs $31,893.13; P=.02), outpatient costs ($20,450.26 vs $16,885.87; P=.005), radiation therapy costs ($314.28 vs $89.81; P=.01), and surgery costs ($3,697.08 vs $2,585.80; P < .001) than patients with limited disease. Patients with extensive pBCC incurred higher costs, greater HRU, and longer time between first and last surgery versus patients with limited pBCC. Early diagnosis and early treatment of pBCC have economic benefits.
Highlights
Basal cell carcinoma (BCC) is the most common skin malignancy and accounts for most malignant eyelid tumors.[1,2] Patients with BCC have a high risk of developing additional BCC tumors, with 33% of patients developing new lesions within 1 year of initial diagnosis.[3,4] Periocular BCC, which involves tissues around the eye, accounts for about 20% of BCCs, and orbital invasion is reported in about 2% of cases.[4] pBCCs of the eyelid or canthi are prone to local recurrence from incomplete treatment.[5]
We investigated real-world healthcare resource utilization (HRU) and costs of patients with limited vs extensive pBCC
To our knowledge, the current study was the first to examine HRU and costs associated with pBCC and showed that patients with extensive pBCC tended to have higher overall HRU and mean costs than those with limited pBCC
Summary
Basal cell carcinoma (BCC) is the most common skin malignancy and accounts for most malignant eyelid tumors.[1,2] Patients with BCC have a high risk of developing additional BCC tumors, with 33% of patients developing new lesions within 1 year of initial diagnosis.[3,4] Periocular BCC (pBCC), which involves tissues around the eye (eyelid, orbit, or lacrimal system), accounts for about 20% of BCCs, and orbital invasion is reported in about 2% of cases.[4] pBCCs of the eyelid or canthi are prone to local recurrence from incomplete treatment.[5]. If left untreated or treated incompletely, pBCC may invade the orbit; this occurs in 0.8% to 5.5% of patients with pBCC.[2] In cases of extensive infiltration of the orbit, more aggressive surgeries, such as orbital exenteration (ie, removal of orbital contents, including the eye) followed by extensive surgical reconstruction may be required in order to achieve a cure, which can lead to permanent disfigurement and/or loss of vision.[2,4] Management of pBCC with orbital invasion requires a multidisciplinary approach and remains challenging.[2] In patients for whom surgery is not possible, advanced or infiltrative pBCC may benefit from hedgehog pathway inhibitors such as vismodegib, long-term results are still pending.[15,16,17,18]
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