Introduction/Background NCCN guidelines recommend the use of systemic therapy for women with advanced endometrial cancer. However, there are no data examining real-world treatment patterns and economic burden in this population. Therefore, this analysis described treatment patterns, and costs in a real-world cohort of endometrial cancer patients initiating systemic treatment.
Methodology Endometrial cancer patients with ≥2 claims for a systemic therapy (i.e., chemo-, immuno- or hormonal therapies) within a 4-week period or a claim for an intrauterine device between June 2014 – September 2018 and having continuous medical enrollment for 6 months prior and 3 months post therapy initiation were identified in the Optum Clinformatics DataMart database. Patients with endometrial cancer-related surgery performed within ±90 days of systemic therapy initiation were not included to exclude adjuvant use. All claims for the same systemic therapy without a >90-day gap or a new systemic treatment initiated within 28 days were a part of the same line of therapy (LOT). We reported the most frequently used treatments and per patient per month (PPPM) healthcare costs for LOT1 and LOT2. All analyses were stratified by the presence of non-endometrial cancers prior to systemic therapy initiation.
Results 2,659 women with endometrial cancer newly initiated systemic therapy (i.e., LOT1), 877 (32.98%) received a LOT2, and 350 (13.16%) had a LOT3. Most patients had a non-endometrial cancer (88.9%) prior to initiating systemic therapy. The treatments received and associated costs in LOT1 and LOT2 are described in table 1 and figure 1, respectively. The median durations of LOT1 and LOT2 were 3.5 and 3.1 months, respectively. The proportions of patients receiving monotherapy in LOT1 and LOT2 were 55.3% and 54.4%, respectively. The mean PPPM total healthcare expenditure over the entire follow-up was $11,109 and outpatient costs ($8,073) accounted for ~75% of this burden. Healthcare expenditure increased as patients moved from LOT1 to LOT2.
Conclusion Both taxanes and platinum-based therapies were used as the primary systemic treatments in this population. The use of targeted and immunotherapies was not common perhaps because the approval of these treatments was recent and not adequately captured in the data. Delaying progression to subsequent LOTs may help reduce the economic burden in this population.
Disclosures This study was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Chizoba Nwankwo is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Anuj Shah, Ruchit Shah, Shelby Corman, and Nehemiah Kebede are employees of Pharmerit, which received consulting fees related to this study.
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