Robert Morlock

Corroboration of claims algorithm for second-line costs of metastatic colorectal cancer treatment with targeted agents

Abstract Objective: To refine a claims algorithm for identifying second-line systemic regimens for metastatic colorectal cancer (mCRC) based on clinical evidence and to compare costs during second-line treatment by targeted therapy administered. Methods: This retrospective analysis of a large US managed care database identified patients diagnosed with mCRC during 1 July 2007–30 June 2011. A claims-based algorithm was developed to identify patients with at least two lines of therapy (LOT) and the second LOT contained one targeted agent: bevacizumab or any anti-epidermal growth factor receptor (EGFR). Medical chart data from 92 patients were used to corroborate and refine the LOT algorithm. The positive predictive value (PPV) of the initial algorithm and refined algorithm for identification of second LOT are presented. The final algorithm was applied to claims data and two mutually exclusive second-line cohorts were examined: patients with bevacizumab- or cetuximab-containing regimens. Second-line healthcare costs were analyzed with generalized linear models adjusted for demographic and clinical characteristics. Results: The PPV increased from 50.0% (95% CI = 39.4–60.6) for the initial algorithm to 72.1% (95% CI = 59.2–82.9) for the final algorithm. Mean age in the cohorts (n = 569) was 61 years; 58% were men. Days of therapy were similar for the bevacizumab (n = 450) vs cetuximab (n = 119) cohorts, respectively: 131 vs 148 in first LOT and 123 (both cohorts) in second LOT (p ≥ 0.27). Total costs during second-line treatment in the bevacizumab cohort were lower by

Patient and physician preferences for anticancer drugs for the treatment of metastatic colorectal cancer: A discrete-choice experiment

12,318 (p = 0.02) and medical costs were lower by

The economic burden of uncontrolled gout: how controlling gout reduces cost

13,809 (p = 0.01). Monthly total and medical costs were lower by

608PPATIENT AND PHYSICIAN PREFERENCES FOR METASTATIC COLORECTAL CANCER TREATMENTS: A DISCRETE CHOICE EXPERIMENT

2728 (p = 0.03) and

A cost-effectiveness analysis of bevacizumab (BV) plus chemotherapy (CT) versus aflibercept (AFLI) plus CT in patients with metastatic colorectal cancer (mCRC) previously treated with BV.

3133 (p = 0.01), respectively. Results are based on commercially or Medicare-insured patients and may not be generalizable to Medicaid or uninsured patients. Conclusions: Corroboration of claim-based algorithms with medical chart data improved algorithm performance. Second-line total and medical costs were lower for mCRC patients treated with bevacizumab compared with cetuximab.

Disease Control, Health Resource Use, Healthcare Costs, and Predictors in Gout Patients in the United States, the United Kingdom, Germany, and France: A Retrospective Analysis

Objective Many publications describe preferences for colorectal cancer (CRC) screening; however, few studies elicited preferences for anticancer-drug treatment for metastatic CRC (mCRC). This study was designed to elicit preferences and risk tolerance among patients and oncologists in the USA for anticancer drugs to treat mCRC. Materials and methods Patients aged 18 years or older with a self-reported diagnosis of mCRC and board-certified (or equivalent) oncologists who had treated patients with mCRC were recruited by two survey research companies from existing online patient panels in the USA. Additional oncologists were recruited from a list of US physicians. Patients and oncologists completed a discrete-choice experiment (DCE) survey. DCEs offer a systematic method of eliciting preferences and quantifying both the relative importance of treatment attributes and the tradeoffs respondents are willing to make among benefits and risks. Treatment attributes in the DCE were progression-free survival (PFS) and risks of severe papulopustular rash, serious hemorrhage, cardiopulmonary arrest, and gastrointestinal perforation. Patients’ and physicians’ maximum levels of acceptable treatment-related risks for two prespecified increases in efficacy were estimated. Results A total of 127 patients and 150 oncologists completed the survey. Relative preferences for the treatment attributes in the study were mostly consistent with the expectation that better clinical outcomes were preferred over worse clinical outcomes. Risk tolerance varied between patients and physicians. On average, physicians were willing to tolerate higher risks than patients, although these differences were mostly not statistically significant. Post hoc latent-class analyses revealed that some patients and physicians were unwilling to forgo any efficacy to avoid toxicities, while others were willing to make such tradeoffs. Conclusion Differences in preferences between patients and physicians suggest that there is the potential for improvement in patients’ well-being. Initiating or enhancing discussions about patient tolerance for toxicities, such as skin rash and gastrointestinal perforations, may help prescribe treatments that entail more appropriate benefit–risk tradeoffs.

Treatment patterns and costs in second-line (2L) metastatic colorectal cancer (mCRC).

Abstract Aim: To evaluate the burden of uncontrolled gout by examining estimated costs and cost drivers. Materials and methods: Data from the 2012 and 2013 US National Health and Wellness Survey (NHWS; 2012 NHWS, n = 71,157 and 2013 NHWS, n = 75,000) were utilized in this study. Based on self-reported gout diagnosis and gout symptoms, respondents were categorized into three groups: controlled gout (n = 344), uncontrolled gout (n = 2,215), and non-gout controls (n = 126,360). Chi-square tests and one-way analysis of variance (ANOVAs) were used to assess group differences on work productivity loss, healthcare resource utilization, and costs. Zero-inflated negative binomial regressions were used to assess the burden of uncontrolled gout on total costs after controlling for covariates. Results: Patients with uncontrolled gout had higher presenteeism, overall work impairment, activity impairment, and number of emergency department visits than those with controlled gout or controls. Overall, uncontrolled gout patients had both higher indirect and total costs compared to patients with controlled gout. After controlling for confounders, those with uncontrolled gout had higher total costs than controlled gout respondents and non-gout controls; there was no significant difference in total costs between patients with controlled gout and non-gout controls. Limitations: Results were based on cross-sectional, self-reported data, making causal inferences more uncertain. Additionally, sample size was small for controlled-gout respondents. Lastly, sampling weights were not used, thus potentially limiting generalizability. Conclusion: Gout can be an expensive condition, particularly if it is not properly controlled. This study provides support that controlling symptoms (e.g. flares) can reduce the economic and societal burden of gout. Therefore, more attention needs to be paid to effective management of gout symptoms.

Characterization and survival of patients with metastatic basal cell carcinoma in the Department of Veterans Affairs: a retrospective electronic health record review

ABSTRACT Aim: To quantify the relative importance of benefits and risks of metastatic colorectal cancer (mCRC) treatments among patients and physicians. Methods: Patients with mCRC and physicians treating patients with mCRC in the United States completed an online discrete-choice experiment survey including questions with pairs of hypothetical mCRC treatments. Respondents were asked to choose their preferred treatment in each question. Treatments were described using 5 outcomes identified through a survey of 5 clinical experts (attributes) and the degree to which treatments induce those outcomes (levels). The attributes in the survey were: progression-free survival (PFS), chance of a severe skin rash, chance of serious bleeding, chance of cardiac arrest, and chance of gastrointestinal (GI) perforation. Chance of serious infusion reactions (SIR) was not included as a study attribute because it comprises multiple possible outcomes. Cardiac arrest was the most severe type of infusion reaction identified by clinical experts and was thus included instead of SIR. Using results from a main-effects random-parameters logit model, attribute importance was calculated as the expected change in treatment choice induced by varying outcomes between clinically relevant levels. Results: 127 patients and 150 physicians completed the survey. Given the clinically-relevant levels for each attribute (PFS: 6-10 months; chance of a severe skin rash: 0-20%; chance of serious bleeding: 0-5%; chance of cardiac arrest: 0-2%; chance of GI perforations: 0-2%) patients considered PFS to be most important, followed by chance of a severe skin rash, serious bleeding, cardiac arrest, and GI perforation. For physicians the most important attribute was PFS, followed by chance of cardiac arrest, severe skin rash, serious bleeding and GI perforation. Conclusions: Patients and physicians agree that PFS is the most important attribute of treatment. Physicians and patients had different rankings for risks suggesting the potential need for additional communication between patients and physicians regarding treatment-related risks. Disclosure: J.M. Gonzalez: Genentech Inc provided funding for this study to RTI-HS. Juan Marcos Gonzalez is an employee of RTI HS. The publication of study results was not contingent on Genentechs approval. RTI HS maintained independent scientific control of the study; S. Ogale: is a full time employee and stock owner of Roche/Genentech; R. Morlock: was paid by Genentech at the time of this work and is not a stock owner of Roche/Genentech; J. Posner: Genentech Inc provided funding for this study to RTI-HS. Joshua Posner is an employee of RTI HS. The publication of study results was not contingent on Genentechs approval. RTI HS maintained independent scientific control of the study; B. Hauber: Genentech Inc provided funding for this study to RTI-HS. B. Hauber is an employee of RTI HS- The publication of study results was not contingent on Genentechs approval. RTI HS maintained independent scientific control of the study.