Retrospective Study of Treatment Costs in Patients with Stage IIIB or IV Non-Small Cell Lung Cancer Who Were Treated with First Line Combination Chemotherapy

• Main Authors: Hsiang-Ju Cheng, 鄭翔如
• Other Authors: Chih-Hsin Yang
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/13340394212410599586

碩士 === 國立臺灣大學 === 臨床藥學研究所 === 94 === Lung cancer is the first and second cause of cancer death for women and men in Taiwan. Nonsmall cell lung cancer accounts for almost 90% of all lung tumors. More than half of them belong to unresectable endstage when they are newly diagnosed. Currently, there is still no chemotherapy regimen considered to be the best. Because chemotherapy costs are expensive, we want to know the survival probability and the treatment costs of endstage nonsmall cell lung cancer patients who were treated with first line combination chemotherapy. Almost half of National Taiwan University Hospital patients who were newly diagnosed of endstage nonsmall cell lung cancer were eligible for participating in clinical trials every year. Most of the previous studies suggested that clinical trials increase in treatment costs over standard treatment. Since the results were still not clear enough and the differences that lie in American and Taiwan’s medical environment, we want to evaluate the effect of participation in nonsmall cell lung cancer clinical trials on patients’ survival and treatment costs in the current study. We also want to evaluate the trend of patients’ survival and medical costs in last five years. There were 440 patients who were treated with first line combination chemotherapy and who were eligible for clinical trials at National Taiwan University Hospital during 2000 to 2005. The median survival for these patients was 14.6 month and the 1-year survival rate was 57.9%. The average six-month cumulative treatment cost for patients was 327,099NTD, the drug cost was 212,420NTD and the chemotherapy cost was 167,434 NTD; the average 1-year cumulative treatment cost for patients was 470,259NTD, the drug cost was 292,733NTD and the chemotherapy cost was 222,123NTD. The average lifetime cost among the patients who were deceased during our study period was 665,964 NTD, and the drug cost and chemotherapy cost were 386,313 NTD and 274,024 NTD. We rearranged the patients into two subgroups by patients participated in the clinical trials or not, Trial group and Nontrial group. For the Trial group, the one-year survival rate was 67.5%, in comparison with 47.5% for Nontrial group. The median survival for Trial patients was significantly longer than Nontrial patients (17.5 month vs. 11.7 month, p=0.02). The average six-month cumulative treatment cost was 10.6% lower for Trial patients than Nontrial patients (306,892NTD vs. 343,201NTD, p=0.06). The average one-year cumulative treatment cost was 1.8% higher for Trial patients than Nontrial patients (475,276NTD vs. 467,057 NTD, p=0.78). The average two-year cumulative treatment cost was 9.6% higher for Trial patients than Nontrial patients (619,001NTD vs. 564,851NTD, p=0.13). The average lifetime cost among the patients who were deceased during our study period was 11.5% higher for Trial patients than Nontrial patients (696,579NTD vs. 624,684NTD, p=0.14). Patients participated in clinical trials received more second or third line chemotherapy. The ICER of Trial group was 14,208 NTD/month. In addition, we rearranged patients who participated in clinical trials into two subgroups according to whether the drugs were provided by pharmaceutical industries or not. The cumulative costs for patients participated in clinical trials with free drug (Trial-free group) were the lowest within 18 months. The first line chemotherapy costs had some effects on the cumulative treatment costs. The treatment regimens of Trial patients who were randomized into control group (Trial-control group) were quite the same with the standard treatments of Nontrial group. There was no significant difference in median survival between Trial-control group and Nontrial group. The median survival of Trial group patients who were randomized into trial group was significantly longer than that of Nontrial group patients. There was an increase trend in patients’ survival rate during 2000-2003. The results displayed that medical costs incurred in 2004 were significantly higher than in 2000. We also found that most of the drug costs come from chemotherapy. Trial group incurred more outpatient costs and Nontrial group incurred more inpatient costs. Patients’ median survival, receiving second line chemotherapy treatment, radiotherapy, surgery, patients with heart disease and those who received free drug while participating in clinical trials were all significant predictors of treatment costs. The median survival of patients participated in clinical trials was significantly longer than patients who were eligible for clinical trials but not participating in clinical trials. Trial group patients also incurred more chemotherapy costs and total treatment costs. After adjustment with survival time, the treatment costs among Nontrial group were higher than Trial group. The ICER of Trial group was 14,208 NTD/month and it should be within the acceptable range of health economics.