Direct hospital costs of skeletal-related events (SRE) in Portuguese patients (pts) with breast cancer (BC) and bone metastases

17084 Background: SRE such as pathological fractures, spinal cord compression, surgery or radiation therapy to bone and tumour- induced hypercalcemia account for substantial health resource utilization (HRU). The objective of this study was to investigate SRE-related direct hospital costs in Portuguese pts with BC and bone metastases. Methods: Pts with BC and at least one SRE within 12 months prior to study entry were eligible for this retrospective medical record review cost analysis study. SRE treatment cost were calculated by multiplying 12 month health resource utilization frequency (hospitalization, clinic visits, diagnostic tests, drugs) by the corresponding unit costs from the Portuguese Ministry of Health costs database. To account for the skewed nature of the data, costs were modelled using generalized linear models with gamma distribution and log link. Results: A total of 121 pts (age at bone metastases, mean 56.8 years, range 21- 89) from six different hospitals in Portugal were included. Median time from BC diagnosis to bone metastases was 38 months [CI95%: 24–57]. ECOG performance status at the time of SRE was 0 in 24.6% of pts, 1 in 45.9%, 2 in 18.0%, 3 in 8.2% and 4 in 3.3%. Total number of SRE over twelve months was 142 (mean 1.2 SRE/pts, SD=0.4) distributed as follows: pathological fractures (12.7%), spinal cord compression (4.9%), surgery to bone (1.4%), radiation therapy to bone (74.7%) and tumour induced hypercalcemia (6.3%) . Mean SRE treatment cost over 12 months was 5,963€ (SD=3,646€): hospitalization 1,312€, clinic visits 36€, diagnostics 103€, radiotherapy 1,481€, drugs 3,031€. According to biphosphonate (Bph) use in the prior 12 months, the mean (SD; pts) unadjusted SRE treatment cost was: no Bph 2,282€ (1,491; n=4), oral Bph 1,579€ (1,123; n=5), zoledronic acid 6,221€ (2,923; n=77), pamidronate 6,766€ (4,476; n=33). When excluding Bph costs, pamidronate pts were 1.8 [95% CI: 1.3–2.7] times more expensive than zoledronic acid when controlling for pts’ clinical characteristics. Conclusions: This study confirms prior data on the high cost of SRE in pts with BC metastatic to bone [Table: see text]

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Palliative Radiation Therapy in the Management of Brain Metastases, Spinal Cord Compression, and Bone Metastases

Seminars in Interventional Radiology ◽

10.1055/s-2007-992324 ◽

2007 ◽

Vol 24 (4) ◽

pp. 363-374 ◽

Cited By ~ 8

Author(s):

Samir Sejpal ◽

Amit Bhate ◽

William Small

Keyword(s):

Spinal Cord ◽

Radiation Therapy ◽

Brain Metastases ◽

Bone Metastases ◽

Spinal Cord Compression ◽

Cord Compression ◽

Palliative Radiation ◽

Palliative Radiation Therapy

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PCN146 HEALTH RESOURCE UTILIZATION OF SUBJECTS RECEIVING DENOSUMAB AND ZOLEDRONIC ACID IN A RANDOMIZED PHASE 3 TRIAL OF ADVANCED BREAST CANCER PATIENTS WITH BONE METASTASES

Value in Health ◽

10.1016/s1098-3015(11)72040-x ◽

2010 ◽

Vol 13 (7) ◽

pp. A279 ◽

Cited By ~ 1

Author(s):

JJ Body ◽

R von Moos ◽

A Stopeck ◽

Y Qian ◽

A Braun

Keyword(s):

Breast Cancer ◽

Zoledronic Acid ◽

Advanced Breast Cancer ◽

Bone Metastases ◽

Cancer Patients ◽

Resource Utilization ◽

Health Resource ◽

Breast Cancer Patients ◽

Health Resource Utilization ◽

Phase 3

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Health resource utilization and patient burden associated with SREs in a randomized controlled trial setting.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19514 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19514-e19514

Author(s):

Jean-Jacques Body ◽

Roger Von Moos ◽

Fred Saad ◽

Gary Edward Richardson ◽

Janet Elizabeth Brown ◽

...

Keyword(s):

Bone Metastases ◽

Solid Tumors ◽

Resource Utilization ◽

Index Date ◽

Controlled Trial ◽

Pathologic Fracture ◽

Cord Compression ◽

Health Resource ◽

Health Resource Utilization ◽

Medical Visits

e19514 Background: Bone metastases (BM) are common in patients (pts) with solid tumors and may result in skeletal related events (SREs) such as spinal cord compression (SCC), pathologic fracture (PF), surgery to bone (SB), and radiation to bone (RT). SREs result in significant morbidity, debilitating pain, decreased health-related quality of life and increased health resource utilization (HRU). Data from 3 registrational phase 3 trials that showed superiority of denosumab over zoledronic acid in patients with solid tumors and BM were combined to assess HRU associated with different SRE types. Methods: Data through 41 weeks for pts with solid tumors and ≥ 1 BM enrolled in these randomized, active-controlled trials were included in this posthoc analysis. HRU were evaluated by SRE type and data were compared between pts with ≥ 1 on-study SRE and those not experiencing an on-study SRE. The index date for pts with on-study SREs was defined as the date that the first SRE was reported. The median time from randomization to incidence of first SRE for each SRE type was used to establish an index date for the control (no SRE) group. The HRU window encompassed a 3-month period (i.e.1 month before and 2 months after the index date) and was assessed by mean number of various types of medical visits during this window. Results: Data from 5,543 pts were included. PF was the most common type of first SRE (n=1,017), followed by RT (n=940), SCC (n=156), and SB (n=74). 3,618 pts did not have an on-study SRE. For all types of medical visits, HRU was higher for pts with an on-study SRE than those without (Table). Conclusions: SREs are associated with increased health resource utilization, reflecting an increased burden for patients with solid tumors and bone metastases. [Table: see text]

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The effect of zoledronic acid on bone metastasis in patients suffering from renal cell cancer (RCC): A German prospective single-arm clinical trial

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.5107 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 5107-5107

Author(s):

U. Tunn ◽

A. Stenzl ◽

M. Kindler ◽

A. Strauss ◽

K. Miller ◽

...

Keyword(s):

Spinal Cord ◽

Zoledronic Acid ◽

Bone Metastasis ◽

Bone Metastases ◽

Treatment Period ◽

Preliminary Analysis ◽

Bone Scan ◽

Cord Compression ◽

Bone Lesions ◽

X Ray

5107 Background: The incidence of RCC increased over the last decades and about 30% of patients will develop bone metastasis. These pts. face considerable skeletal morbidity e.g. bone pain, pathologic fractures, spinal cord compression or tumor induced hypercalcemia (TIH). A prospective trial was initiated in RCC metastatic to bone evaluating the SRE (skeletal related event) rate under therapy with zoledronic acid (ZA). Primary objective was the proportion of pts. with at least one SRE after 12 months. Methods: Patients with RCC must have had ≥1 bone metastasis and ≤2 prior applications of a bisphosphonate. Bone lesions were diagnosed by bone scan and ≥1 lesion was confirmed using X-ray, CT or MRI. Pts. passed a 12 months treatment period receiving 4 mg ZA every 3 weeks. Pts. were followed every 3 weeks for 54 weeks for development of SREs (radiation or surgery to bone, spinal cord compression, pathologic bone fractures) and TIH. A bone scan was done, if AP or LDH were >2xULN or symptoms occurred. Suspected SRE was confirmed by X-ray, CT or MRI. After end of treatment patients entered a survival follow-up. Results: 51 pts. participated in the study. Median age was 63 years and 2/3 were male. Proportions of MSKCC risk groups good/intermediate/poor for pretreated pts. were 8%, 56%, and 18%, respectively. 78% of pts. suffered from ≤6 bone metastases. 18% had already experienced at least one SRE before study entry. 26% obtained prior medications, mainly interferons (20%), interleukins (16%) and chemotherapy (16%). 25 pts. completed the 12 months treatment period. Based on a preliminary analysis 13 pts. (26%) experienced at least one SRE with an absolute number of 23 events. No TIH was observed. Bone lesions response was observed in 3 pts. (2 CR, 1 PR) out of 33 pts. currently available. Final efficacy and safety results of the 12 months treatment phase will be shown at presentation. Conclusions: Pts. with mRCC and bone metastases are at high risk for experiencing an SRE with a reported incidence of up to 74%. This is the first study prospectively evaluating SRE rate in patients with mRCC and bone lesions receiving ZA. A preliminary analysis indicates an SRE-rate of 26% and no TIH was observed. Final results of this trial could further support the use of ZA in mRCC. [Table: see text]

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