Bremner, K.

Chan, K.

de Oliveira, C.

Gunraj, N.

Krahn, M.

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PCN38 FIRST-YEAR COSTS FOR THE 19 MOST COMMON CANCER DIAGNOSES IN ONTARIO 

METHODS: Using Surveillance, Epidemiology, and End Results (SEER) cancer regis-
try data linked to Medicare claims, we identified 1,117 FL patients diagnosed be-
tween 01/99 and 12/05. Patients were included if chemotherapy began within 90
days of cancer diagnosis and consisted of CHOP (cyclophosphamide [C], doxorubi-
cin, vincristine [V], and prednisone [P]) or CVP rituximab. Monthly Medicare paid
amounts were calculated for each of 48 monthly partitions following chemother-
apy initiation. To account for censoring we conducted 48 inverse probability-
weighted (IPW) least-squares regression analyses to examine patient factors asso-
ciated with cumulative costs after each partition. Total costs were divided into
chemotherapy and non-chemotherapy. Overall survival was estimated using Ka-
plan-Meier analysis. RESULTS: The median age was 73 years, 56% were diagnosed
with stage III-IV disease, 67% received rituximab, and, among these, the average
cost of rituximabwas $17,958 during the first 12months of frontline therapy. In IPW
regression, the incremental cumulative total cost associated with rituximab was
$20,622 (95% Confidence Interval [CI] $16,999-$24,092) at month 6, $19,606 (95% CI
$14,996-$23,914) at month 12, and $18,122 (95% CI $8,110-$27,533) at month 48.
Other factors associated with higher costs were later cancer stage and higher co-
morbidity index. The cumulative chemotherapy cost associated with rituximab
was $18,109 (95%CI $16,081-$20,365) atmonth 6, $16,249 (95%CI $13,820-$19,023) at
month 12, and $16,130 (95% CI $11,320-$21,015) at month 48. There were no differ-
ences in cumulative non-chemotherapy costs associated with rituximab at any
time. Kaplan-Meier 48-month survival was 74.4% for rituximab and 62.6% for non-
rituximabpatients.CONCLUSIONS:Thenet cost of rituximab is consistentwith the
cost of rituximab treatment, suggesting that over 48 months additional costs from
improved survival were balanced by the reduced need for medical services.
PCN35
DOSING PATTERN AND COST COMPARISON OF EPOETIN ALFA AND
DARBEPOETIN ALFA IN CHRONIC KIDNEY DISEASE AND CHEMOTHERAPY-
INDUCED ANEMIA INPATIENTS
Lafeuille MH1, Bailey RA2, Senbetta M2, McKenzie RS2, Lefebvre P1
1Groupe d’analyse, Ltée, Montreal, QC, Canada, 2Centocor Ortho Biotech Services, LLC, Horsham,
PA, USA
OBJECTIVES: To compare erythropoiesis-stimulating agent (ESA) dosing patterns
and costs in inpatients with chronic kidney disease (CKD) not on dialysis or with
chemotherapy-induced anemia (CIA).METHODS: Electronic records from the Pre-
mier Perspective Comparative Hospital Database (2006Q1-2009Q4) were analyzed
to identify inpatients 18 years old treated with epoetin alfa (EPO) or darbepoetin
alfa (DARB). Patients receiving renal dialysis or treated with both ESAs were ex-
cluded. CKDpatients had1 claim for CKD, no claim for cancer, and did not receive
chemotherapy. CIA patients had1 claim for cancer, received chemotherapy, and
had no claim for CKD. The mean cumulative ESA dose was used to calculate costs,
based on April 2010 wholesale acquisition costs (EPO: $15.15/1,000 Units, DARB:
$4.96/mcg). RESULTS: A total of 148,746 CKD (EPO: 116,017; DARB: 32,729) and
13,832 CIA (EPO: 10,454; DARB: 3,378) patients were identified. EPO patients were
slightly younger than DARB patients in the CKD group (years: 71.0 vs. 71.2; P.0199)
and slightly older in the CIA group (years: 60.7 vs. 59.2; P.0001). The proportion of
females was higher in CKD (EPO 52.3% vs. DARB 51.3%; P.0018) and similar in CIA
(EPO 52.9% vs. DARB 53.8%; P .3722). The mean length of stay (LOS) was slightly
longer for EPO patients (days: CKD: 9.9 vs. 9.7, P.0006; CIA: 13.4 vs. 12.6; P.0028).
The mean cumulative dose was EPO 37,333 Units and DARB 149 mcg for CKD pa-
tients, and EPO 62,605Units andDARB 272mcg for CIA patients, yielding dose ratios
of 251:1 and 230:1 (Units EPO:mcg DARB), respectively. Corresponding ESA costs
were higher for DARB than for EPO in both populations (CKD: $739 vs. $566; CIA:
$1,349 vs. $948). CONCLUSIONS: This analysis reported dose ratios of 251:1 and
230:1 and a cost premium associated with DARB of 31% and 42% for CKD and CIA
inpatients, respectively, despite longer LOS for EPO patients.
PCN36
COST ANALYSIS, SAFETY, AND EFFICACY OF PEMETREXED/CISPLATIN
COMPARED WITH BEVACIZUMAB/GEMCITABINE/CISPLATIN IN PATIENTS
WITH PREVIOUSLY UNTREATED ADVANCED NON-SQUAMOUS NSCLC IN
RUSSIA
Davey P1, Rajan N2, Kanivets Y3, Barraclough H2, Orlando M4, Brnabic AJ5, Han B6
1Illuminate Health Consulting, Sydney, NSW, Australia, 2Eli Lilly Australia Pty Ltd, West Ryde,
NSW, Australia, 3Eli Lilly Vostok S.A., Moscow, Russia, 4Eli Lilly Interamerica Inc, Buenos Aires,
Argentina, 5Eli Lilly Australia Pty Ltd, Sydney, NSW, Australia, 6Eli Lilly and Company,
Indianapolis, IN, USA
OBJECTIVES: The novel chemotherapy agent pemetrexed combined with cisplatin
and the vascular endothelial growth factor (VEGF)-targeted agent bevacizumab
combined with cisplatin and gemcitabine are approved as first-line treatments for
patients with non-squamous non-small cell lung cancer (NSCLC). Recent studies
have claimed that bevacizumab has equivalent safety and is cost-saving when
comparedwith pemetrexed in this population. This study analyzed the health care
costs in Russia based on the indirect analysis and local treatment practice. Safety
and efficacy were also compared.METHODS: As no direct head-to-head trials have
been undertaken comparing the two regimens, an indirect treatment comparison
approach was used. Data from 2 separate studies, that had a common comparator
(cisplatin/gemcitabine), were analyzed. Only the 7.5 mg bevacizumab arm was
included. The cost analysis comprised chemotherapy and adverse event treatment
costs. Chemotherapy costs were based on the average number of cycles in the
trials. Safety and efficacy endpoints were matched from the available data. Previ-
ous studies had assumed equivalent safety and used median number of cycles for
the calculation of drug costs when the cycles of bevacizumab are not normally
distributed. RESULTS: The overall proportion of patients suffering a severe adverse
event was significantly lower with pemetrexed (10.50; 95%CI 18.4, 2.71). No
significant differences were found in overall survival (HR 0.90; 95%CI 0.72, 1.13),
although in the individual trials only pemetrexed demonstrated significant sur-
vival advantage (HR 0.84; 95%CI 0.74, 0.96) while 7.5 mg bevacizumab showed no
survival advantage (HR 0.93; 95%CI 0.78, 1.11). When costs were based on the aver-
age number of cycles used on a per-patient basis (4.3 vs. 7.2), pemetrexed was
cost-saving (saving R337,600 or $US11,100) with most savings from chemotherapy
costs to pharmacy (R334,100 or $US10,900). CONCLUSIONS: Pemetrexed is cost-
saving and less toxic compared to bevacizumab in this patient population, and
produces at least equal survival outcomes.
PCN37
ESTIMATING COST OF TREATMENT IN ELDERLY PATIENTS WITH COLORECTAL
CANCER USING MEDICARE DATA
Kokkotos F, Shen S, Wang Z, Zhang Y
Trinity Partners, LLC, Waltham, MA, USA
OBJECTIVES: Coloretal cancer (CRC) is one of the most common and costly cancer
in the United States. 70% of the patients are diagnosed post 65 years old. This study
used a large cohort of patients from 2005-2008 100% Medicare Institutional Inpa-
tient and Outpatient data to estimate the cost of different treatments and under-
stand the chemotherapy use for CRC patients. METHODS: 203,532 (50.8% Female)
CRC patients that were age 65 or older with a mean Charlson Comorbidity Index
(CCI) of 2.30 ( 3.26) were identified by ICD-9 code 153.x and/or 154.x. The overall
cost for patient groups with different characteristics was compared by using stan-
dard t-test,Wilcoxon test or ANOVA. The costwas furthermodeled in a generalized
linear model (GLM) with a log-link and gamma distributed variance functions.
RESULTS: 38% of CRC patients had surgery, 6.0% conducted radiotherapy and 5.7%
received chemotherapy. Patients on chemotherapy were incurred with the highest
cost ($41,867), followed by radiotherapy ($13,812) and surgery ($4,964). Patients on
5-FU, Leucovorin, Oxaliplatin and Bevacizumab (5-L-O-B) had the highest esti-
mated cost ($52,158), as its patient populationwas themost severe (Mean CCI7.6),
followed by 5-FU, Leucovorin and Oxaliplatin (5-L-O) ($39,435, Mean CCI4.6). The
average cost for other chemotherapies was $30,838. Most colon cancer patients
(2,761 patients) used the drug combination of 5-L-O and 5-L-O-B (1,450 patients).
Oxaliplatin and Bevacizumab were administered at a lower dose when used in
combination with other drugs than used alone. About 60% of the patients received
these combinations as adjuvant therapy after surgery. CONCLUSIONS: This study
provided information on the average annual cost of elderly CRC patients by treat-
ment type and disease comobidity. The analysis illustrated the utilization of che-
motherapy in CRC treatment: the common drug combinations and its costs, dosing
and administration information as well as chemotherapy use after surgery.
PCN38
FIRST-YEAR COSTS FOR THE 19 MOST COMMON CANCER DIAGNOSES IN
ONTARIO
de Oliveira C1, Bremner K1, Chan K2, Gunraj N3, Krahn M4
1University Health Network, Toronto, ON, Canada, 2Sunnybrook Health Sciences Centre, Toronto,
ON, Canada, 3Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, 4Toronto Health
Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
OBJECTIVES: The first year after cancer diagnosis is a period of intensive treatment
and high cost. Our objective is to estimate the first year costs for patients initially
diagnosed with one of the 19 most common cancers in Ontario between 1997 and
2007. METHODS: We selected patients who were diagnosed at 19 years of age or
older, with valid ICD-O and histology codes, who survived more than 30 days after
diagnosis, and had no second cancer within 90 days of the initial cancer from the
Ontario Cancer Registry (N 412,787). We linked these patients to health care ad-
ministrative databases, and radiation therapy data from Cancer Care Ontario. We
defined the health care resources to be costed and developed suitable costing
methodologies. We examined health care resource use and calculated mean costs
for each type of cancer in the first year after diagnosis. RESULTS: Patients with
myeloma and brain cancer incurred the highest mean first-year costs ($71,892
and $65,629, respectively); patients with melanoma, uterine and prostate can-
cers had the lowest mean costs ($21,050, $29,115 and $29,309 respectively). The
most costly resources for all cancer types were hospitalizations (38% of total
costs) and physician services (28% of total costs). Surprisingly, chemotherapy
and radiation therapy contributed very little to the total (4% and 1%, respec-
tively). Previous research on first-year costs for patients aged 65 in the US also
found that brain and other nervous system cancers had the highest cost of care
while melanoma of the skin had the lowest cost; hospitalization was also the
costliest resource. CONCLUSIONS: The first-year costs of cancer care in Ontario
are substantial and vary by tumour site. Hospitalizations and physician services
comprise a large portion of the costs for all cancer types. These estimates will
improve the quality of future cancer-related economic evaluations and are of value
to researchers and policy makers.
PCN39
COSTS AT THE END OF LIFE FOR PATIENTS WITH CASTRATION-RESISTANT
PROSTATE CANCER (CRPC)
Alemayehu B1, Parry D2, Engel-Nitz NM3, Kulakodlu M3, Nathan F1
1AstraZeneca, Wilmington, DE, USA, 2AstraZeneca, Macclesfield, Cheshire, UK, 3i3 Innovus,
Eden Prairie, MN, USA
OBJECTIVES: Recent research describes decreasing quality of life for patients with
CRPC at the end of life, but less is known about accompanying changes in health
care costs. This study aimed to examine costs at the end of life for patients with
CRPC who died compared to patients alive at the end of the study period.
METHODS: A retrospective study design used medical and pharmacy claims and
lab results (2001-2007) to identify patients with CRPC from a large U.S. managed
A161V A L U E I N H E A L T H 1 4 ( 2 0 1 1 ) A 1 – A 2 1 4


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PCN38 FIRST-YEAR COSTS FOR THE 19 MOST COMMON CANCER DIAGNOSES IN ONTARIO

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