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Curr Med Res Opin. 2019 Oct;35(10):1761-1767. doi: 10.1080/03007995.2019.1623185. Epub 2019 Jul 5.

Healthcare resource utilization and associated cost analysis of the PROCLAIM study in patients with stage III non-small-cell lung cancer.

Author information

1
Department of Medical Oncology, Washington University School of Medicine , Saint Louis , MO , USA.
2
Department of Radiation Oncology, VU University Medical Center , Amsterdam , The Netherlands.
3
Department of Pulmonology, Mathias - Spital Rheine , Rheine , Germany.
4
Department of Medical Oncology, Hospital Puerta de Hierro , Madrid , Spain.
5
Department of Lung Cancer, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences , Guangzhou , China.
6
Department of Medicine, National and Kapodistrian University of Athens , Athens , Greece.
7
Department of Pulmonology, Hospital CUF Porto , Porto , Portugal.
8
Department of Health Economics, RTI Health Solutions , Research Triangle Park , NC , USA.
9
Department of Biostatistics, RTI Health Solutions, Research Triangle Park , NC , USA.
10
Eli Lilly and Company , Neuilly-sur-Seine , France.
11
Eli Lilly and Company , Indianapolis , IN , USA.
12
Lilly España , Madrid , Spain.
13
Department of Medicine, University of Chicago , Chicago , IL , USA.

Abstract

Objective: To analyze patient-reported swallowing difficulties, healthcare resource utilization and associated costs during the PROCLAIM study. Methods: Patients with stage III non-squamous non-small cell lung cancer received pemetrexed-cisplatin (PemCis) combined with concurrent thoracic radiotherapy followed by consolidation pemetrexed, or concurrent chemoradiotherapy with etoposide-cisplatin (EtoCis) followed by standard consolidation chemotherapy. Patient - reported swallowing function was measured using diaries. Resource utilization (hospitalizations, transfusions, concomitant medications) was compared between treatment arms using Fisher's exact test and independent t-test. Medical resource use costs were analyzed using nonparametric Wilcoxon rank sum test. Results: Patient-reported difficulty in swallowing function (diary score ≥4) was 33.8% in the PemCis arm and 29% in the EtoCis arm. Overall resource use, including hospitalizations, was similar between treatment arms; however, fewer patients in the PemCis arm received transfusions and selected concomitant medications. Concurrent phase analyses were consistent with the overall study. A significantly lower percentage of patients (31.1% vs. 40.8%) were hospitalized in the PemCis arm. Total costs were significantly higher in the PemCis arm. Other medical costs (excluding study treatment costs) during the concurrent phase were lower for patients in the PemCis arm, due to significantly lower hospitalization costs and lower use of concomitant medications. Subgroup analysis yielded similar results. Conclusions: Patient-reported difficulty in swallowing post-baseline and resource utilization were consistent with previously reported safety outcomes. In the overall study, higher total costs for PemCis were driven by study drug cost. When adjusting for treatment duration, other monthly medical costs were favorable to PemCis. Patients on pemetrexed remained longer on therapy, suggesting better tolerability. ClinicalTrials.gov identifier: NCT00686959.

KEYWORDS:

PROCLAIM; Stage III NSCLC; cost analysis; pemetrexed; resource utilization

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