Total and segmented direct cost-of-care for stage IV non-small cell lung cancer in a privately insured population

dc.contributor.advisorKoeller, Jimen
dc.contributor.committeeMemberFrei, Christopheren
dc.contributor.committeeMemberRyan, Laurajoen
dc.contributor.committeeMemberPenrod, Johnen
dc.creatorBell, Allison Miriamen
dc.date.accessioned2011-07-12T17:20:27Zen
dc.date.available2011-07-12T17:20:27Zen
dc.date.issued2011-05en
dc.date.submittedMay 2011en
dc.date.updated2011-07-12T17:20:33Zen
dc.descriptiontexten
dc.description.abstractIntroduction: New treatments for stage IV (adv) NSCLC have emerged this past decade. Recent pharmacoeconomic research has focused on cost of treatment, comparative costs of therapies, and cost/cost effectiveness of adding a biologic to traditional therapy. Drug cost is thought to be a primary driver of cost change in NSCLC, yet to our knowledge, characterization of the direct cost of NSCLC has not been published since the new treatments have emerged in the guidelines. Our primary objective was to characterize the direct and segmented cost of adv NSCLC from 2000-9. We also want to determine cost impact of new therapies, and cost trend from 2000-9. Methods: This PharMetrics claims database study includes diagnosed NSCLC patients [greater than or equal to] 20 yo. Small cell lung cancer was excluded. Claims were divided into disease segments and time periods representative of changes in therapy ("pre" (2000-2), "transition" (2003-5), and "current" (2006-9) periods). Descriptive statistics (median, interquartile range (IQR)), chi-square test (nominal data), and Wilcoxan rank sum tests were performed on the data. To adjust for baseline confounders, multivariate least squares regression models were created. Results: Costs are reported as medians in terms of per patient per month (pppm). Overall monthly cost (n=969) was $10,281 pppm. Diagnosis cost $6,601 pppm, active treatment cost $9,287 pppm, and end-of life cost $12,215 pppm. There was no difference in cost between the “transition” (n=439) and “current” (n=503) periods overall or for any segment of disease. Comorbidities had no effect on cost. For patients receiving at least 5 months of active treatment medication (n=316) total median cost was $144,147 per patient ($9,371 pppm). Discussion: There was no difference in cost between the transition and current periods, in regards to either overall cost or segmented cost. The most expensive segment was end-of-life, with a median cost exceeding $12,000 pppm. Surprisingly, comorbidities had no effect on cost. Newer agents (biologics, TKIs, and pemetrexed) represent only a modest portion of cost, with a majority of cost for stage IV NSCLC comprised of non-drug costs.en
dc.description.departmentPharmaceutical Sciencesen
dc.format.mimetypeapplication/pdfen
dc.identifier.slug2152/ETD-UT-2011-05-3094en
dc.identifier.urihttp://hdl.handle.net/2152/ETD-UT-2011-05-3094en
dc.language.isoengen
dc.subjectPharmacoeconomicsen
dc.subjectLung canceren
dc.subjectMetastaticen
dc.subjectMedical care, Cost ofen
dc.subjectLungsen
dc.subjectHealth insuranceen
dc.subjectNSCLCen
dc.titleTotal and segmented direct cost-of-care for stage IV non-small cell lung cancer in a privately insured populationen
dc.type.genrethesisen
thesis.degree.departmentPharmacyen
thesis.degree.disciplinePharmacyen
thesis.degree.grantorUniversity of Texas at Austinen
thesis.degree.levelMastersen
thesis.degree.nameMaster of Science in Pharmacyen
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