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dc.contributor.authorAly, A.
dc.contributor.authorJohnson, C.
dc.contributor.authorYang, S.
dc.date.accessioned2019-09-13T16:42:00Z
dc.date.available2019-09-13T16:42:00Z
dc.date.issued2019
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85063472361&doi=10.1080%2f13696998.2019.1591424&partnerID=40&md5=408658cdb3602c5db2ffd296cd832055
dc.identifier.urihttp://hdl.handle.net/10713/10706
dc.description.abstractAims: Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT), but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, the economic burden of chemotherapy-based mUC treatments among US Medicare patients was estimated. Methods: Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third or greater [LOT3+]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, and maximum LOT received. Results: Among 1,873 eligible patients with mUC (median age = 77 years; median follow-up = 7.5 months), 1,035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had LOT3+. Median OS was 8.1 months, range was 4.3 (untreated) to 29.8 (LOT3+) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated = $57,207; LOT1 = $99,213; LOT2 = $125,190; LOT3+ = $163,884). Mean per patient per month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated = $27,211; LOT1 = $9,601; LOT2 = $7,325; LOT3+ = $6,017). Limitations: Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients. Conclusions: Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically relevant economic benchmark for mUC treatment across different traditional LOTs. Copyright 2019 The Author(s).en_US
dc.description.urihttps://doi.org/10.1080/13696998.2019.1591424en_US
dc.language.isoen-USen_US
dc.publisherTaylor and Francis Ltden_US
dc.relation.ispartofJournal of Medical Economics
dc.subjecteconomic burdenen_US
dc.subjecthealthcare resource useen_US
dc.subjectline of therapyen_US
dc.subjectMetastatic urothelial carcinomaen_US
dc.subjectSEER-Medicareen_US
dc.titleOverall survival, costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinomaen_US
dc.typeArticleen_US
dc.identifier.doi10.1080/13696998.2019.1591424
dc.identifier.pmid30836812


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