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Abstract
Introduction/Background There are little data describing the economic burden of cervical/endometrial cancers. Therefore, this study aimed to estimate the incremental lifetime economic burden among newly diagnosed cervical and endometrial cancer patients versus non-cancer controls using a phase-based costing approach.
Methodology Cervical and endometrial cancer patients newly diagnosed between January 2015 – June 2018, with continuous enrollment for 12 months prior and 6 months post diagnosis were identified in the Optum Clinformatics DataMart database. Non-cancer controls included patients who did not have any cancer diagnosis and had at least 18 months of continuous enrollment in the data. The index date was the date of the first diagnosis for cancer cases and the first claim date after 12 months of continuous enrollment for non-cancer controls. Both cases and controls were followed until death/loss of enrollment/end of data availability. Cancer patients were matched with non-cancer controls on the propensity of receiving a cervical/endometrial cancer diagnosis, index year, and year of last follow-up.
Per patient per month (PPPM) costs (outpatient, inpatient, ER, pharmacy) attributable to cervical and endometrial cancer were calculated for the following 4 phases: pre-diagnosis (3 months prior to diagnosis), initial (6 months post-diagnosis), terminal (6 months pre-death), and continuation (any remaining time between initial and terminal phases). Survival data were obtained (cases: Surveillance, Epidemiology, and End Results registry; controls: United States life tables) to determine the monthly proportion of patients in each phase of care. Total survival adjusted monthly cost were obtained by multiplying the proportion of patients in each phase by the total cost incurred during that month (figures 1 and 2). Generalized linear models were used to assess phase-specific incremental costs attributable to cervical and endometrial cancer.
Results The analytic cohort included 1,002 cervical cancer patients and 4,005 matched non-cancer controls, and 5,003 endometrial cancer patients matched with 19,999 non-cancer controls. The incremental total PPPM phase-specific costs attributable to cervical and endometrial cancer were: pre-diagnosis (cervical: $1,057; endometrial: $3,315), initial (cervical: $12,084; endometrial: $8,618), continuation (cervical: $2,732; endometrial: $1,147), and terminal (cervical: $2,702; endometrial: $5,442). Incremental costs were significantly higher for cancer patients versus non-cancer controls across all phases of care (except terminal phase costs for cervical cancer). Outpatient costs were the major driver of costs across all post-diagnosis phases (figure 1 and 2).
Components of total costs by phase of care among cervical cancer patients and non-cancer controls
Components of total costs by phase of care among endometrial cancer patients and non-cancer controls
Conclusion The mean phase-specific costs followed the following order: Terminal > Initial > Continuation > Pre-diagnosis. This study highlights the substantial cost burden associated with cervical/endometrial cancer, and cost variation by phases of care.
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., Kenilworth, NJ, USA. Anuj Shah, Ruchit Shah, Shelby Corman, and Nehemiah Kebede are employees of Pharmerit International, which received consulting fees related to this study.