bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stem cell transplant and financial toxicity: A single-center prospective cohort analysis.
Authors: Hussaini Syed , Ren Yi , Lew Meagan , Bohannon Lauren , Thompson Jillian C , Zafar Yousuf , Sung Anthony Derek 
Published: May 2020

e19373 Background: Increasing healthcare costs often result in many individuals and families foregoing required care, delaying care, or non-adhering to prescribed medication. Hematopoietic cell transplantation (HCT) is a highly specialized procedure that has the potential to adversely affect the socioeconomic well-being of patients and their family. Financial well-being in patients undergoing evaluation for HCT has been inadequately studied. In this prospective cohort study, we examined financial toxicity in a cohort of patients being considered for HCT at the Duke Adult Bone Marrow Transplant Clinic. Methods: This is a prospective cohort review of patients age ≥18 years undergoing evaluation for allogeneic HCT between 1/1/2017 – 1/1/2020. Patients that completed a baseline financial health survey and the comprehensive score for financial toxicity-functional assessment of chronic illness therapy (COST-FACIT) survey were included. Financial health was measured via baseline survey and financial distress was assessed via the validated COST-FACIT measure. The primary outcome was financial distress. Results: Of 157 consecutive patients, 112 (71.3%) completed financial toxicity assessments. Of these, 63.4% were male, had a mean age of 61.0, were predominantly white (74.4%), and majority had household incomes less than $90,000 (53.7%). Primary diagnosis at screening was leukemia (35.4%) and myelodysplastic neoplasm (31.7%). Overall, 94.5% noted an inability to see a physician in the prior year due to cost, 76.8% had not filled a prescription due to cost, 73.2% reduced spending on basics like food or clothing to pay for cancer care, 69.5% borrowed money or used a credit card to pay for cancer care, 54.9% used all or a portion of their savings to pay for cancer care, and 54.9% reduced spending on leisure activities like vacations, eating out, or movies to pay for cancer care. Overall, 31 (37.8%) respondents noted mild financial distress while 26 (34.1%) noted moderate-to-high financial distress. Conclusions: Previous studies in the solid tumor and hematological malignancy fields have noted similar results in financial toxicity. However, this is the first study of its kind to demonstrate prevalent financial toxicity present in a cohort of patients undergoing evaluation for HCT. Early interventions by physician and social work led teams may benefit patients who are at risk for financial distress. Future directions include investigating factors associated with high financial toxicity in HCT, and whether financial distress is related to worse outcomes after transplant.
Association of hospital type with prices, spending, and acute care utilization among privately insured patients undergoing cancer surgery.
Authors: Takvorian Samuel U , Yasaitis Laura , Liu Manqing , Lee Daniel J. , Werner Rachel M. , Bekelman Justin E. 
Published: May 2020

e19376 Background: With annual cancer spending estimated to surpass $170 billion in 2020, national attention has focused on the prices and utilization of cancer care. This is particularly important for privately insured patients, for whom healthcare prices are negotiated between insurers and providers and price transparency is lacking. Among privately insured patients undergoing common cancer surgery, we examined the relation between hospital type and prices, spending, and utilization. Methods: We conducted a retrospective study using Health Care Cost Institute’s multipayer national commercial claims data. The study population included patients with breast, colon or lung cancer undergoing cancer surgery from 2011-2014. The exposure was hospital type at which surgery was performed: National Cancer Institute (NCI), academic, or community. Spending outcomes were surgery-specific prices paid and 90-day total episode spending. Utilization outcomes were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90 days. We estimated mean risk-adjusted spending and utilization outcomes for each hospital type using generalized linear mixed-effects models, adjusting for patient, hospital and region characteristics. Results: We identified 66,878 patients with incident breast (53.5%), colon (32.0%), or lung (14.5%) cancer undergoing cancer surgery at 2,995 hospitals (8.3% at NCI; 16.3% academic; 75.4% community). Treatment at NCI cancer centers was associated with higher surgical prices paid ($18,310 at NCI v $14,703 at community hospitals; diff +$3,607; p < 0.001) and 90-day total episode spending ($46,462 v $41,274; diff +$5,188; p = 0.008). There were no significant differences in LOS, ED use or hospital readmission within 90 days. Conclusions: Among privately insured patients undergoing cancer surgery, NCI cancer centers had higher surgical prices and episode spending without differences in utilization, compared to community hospitals. A better understanding of the drivers of prices and spending at NCI cancer centers is needed. [Table: see text]
Estimating productivity losses for cancer patients and caregivers of cancer patients.
Authors: Chiu Kevin , MacEwan Joanna P. , Bognar Katalin , Peneva Desi , May Suepattra Grace , Zhao Lauren , Yong Candice , Amin Suvina , Bolinder Bjorn , Batt Katharine , Baumgardner James 
Published: May 2020

e19381 Background: Although cancer is a leading cause of illness in the United States, its true impact on productivity is poorly understood. Traditional approaches to capturing health-related productivity loss—e.g., the human capital method—focus on patients’ foregone wages, overlooking fringe benefits and the impacts incurred by caregivers and co-workers. Thus, the value of lost productivity is often underestimated. We sought to comprehensively estimate productivity loss incurred by working-age cancer patients and unpaid caregivers in the United States. Methods: We conducted a cross-sectional survey study of (i) non-small cell lung cancer (NSCLC) and breast cancer (BC) patients, and (ii) unpaid caregivers. To measure loss associated with absenteeism and presenteeism, participants reported pre- and post-cancer diagnosis income, hours worked, and time to complete tasks. The “multiplier effect” method was used to measure productivity loss incurred by co-workers due to patient or caregiver absenteeism and/or presenteeism. Exploratory multivariable analyses controlled for cancer type, stage, age, time since diagnosis, oncogene mutation status, and industry sector. Results: A total of 404 participants (104 BC, 100 NSCLC patients; 100 BC, 100 NSCLC caregivers) completed the surveys. Of these, 319 participants (162 BC, 157 NSCLC) who worked ≥40 weeks in the year pre-diagnosis and who did not transition from part- to full-time work after diagnosis were included in the analysis. Over a third of the NSCLC (33%) and BC (43%) patients left the workforce after diagnosis. For patients, estimated mean annual productivity loss equaled $123,792 (144% of mean income pre-diagnosis) for NSCLC and $123,502 (209% of mean income pre-diagnosis) for BC. For caregivers, the estimated mean annual productivity loss was $90,421 (108% of mean income pre-diagnosis) for NSCLC and $143,839 (190% of mean income pre-diagnosis) for BC. Exploratory analyses also found that patient age and stage at diagnosis were positively correlated with a greater absenteeism effect. Conclusions: This study found that traditional approaches, such as the human capital method, significantly underestimate productivity loss in cancer patients and caregivers. Holistic approaches that include lost wages, fringe benefits, and teamwork effects, are better approaches to understanding the amplified impact cancer can have for patients, caregivers, and co-workers.
Early physician spillover responses to the oncology care model.
Authors: Walker Brigham 
Published: May 2020

e19393 Background: As Medicare increasingly seeks to transform beneficiary care through provider reimbursement incentives, there is a possibility that non-beneficiary care will change too. There is limited information on how the Oncology Care Model (OCM) has affected care in this way. This study seeks to analyze the early utilization and cost effects of the OCM on the non-Medicare population. Methods: This was a retrospective analysis of a large physician network comprised of OCM participants and non-participants alike. The data spanned July 1st, 2015 to June 30th, 2017 – one year before and after the launch of the OCM. Several states are represented, and this population includes about 20% of the non-hospital-based community oncology footprint. A difference-in-differences approach was used to compare primary first-year effects on the Medicare population with first-year spillover effects on the Medicare Advantage (MA), private, and Medicaid populations. The utilization and costs of care under management of the practices were evaluated. Effects of the OCM for breast, lung, colon, and prostate cancer among Medicare, MA, private, and Medicaid populations at the physician-by-month level are estimated. Results: The OCM appears to have reduced office visits for Medicare breast cancer and colon cancer. These effects look to have spilled over to the Medicaid breast cancer population, but not elsewhere. The OCM also modestly decreased overall costs for each sub-type but these reductions were not observed in the non-Medicare populations. Conclusions: This research was not randomized, so un-observable differences between groups unrelated to the OCM could drive these results. It is also limited to practice-based care and does not include hospital or pharmacy care. Finally, these are first year effects and the literature suggests that effects can develop for a few years after program launch. That said, this paper suggests that care patterns appear to have changed under the OCM for both Medicare and non-Medicare lives, but not uniformly.
Establishing the six-month resource utilization and cost-of-care for the treatment of first-line metastatic BRAF (V600) melanoma with combination BRAF and MEK inhibitors.
Authors: Halloush Shiraz , Huber Stephen , Kim Hanna , Koeller Jim M. 
Published: May 2020

e19396 Background: Comparative data on cancer therapy health care resource utilization (HCRU) and associated cost will be helpful as value-based healthcare moves forward. BRAF & MEK inhibitor combinations are considered first-line treatment for BRAF (V-600) metastatic melanoma (MM), although head-to-head trials are lacking. We aimed to establish the real-world HCRU and 6-month (mo) cost-of-care in V-600 MM treated with BRAF & MEK inhibitor therapy. Methods: A single data team in 2018 performed a multicenter, retrospective chart audit of adult patients with BRAF V-600 MM. Four institutions from across the US with patients who had received either dabrafenib + Trametinib (DT) or vemurafenib + cobimetinib (VC) were enrolled. In the most recent 12 mo period, data was captured from the start of therapy for 6 mo or until therapy was stopped. Dose change or stoppage was accessed for cause (toxicity, disease, death, other). Variables included hospitalization, emergency room (ER), all clinic visits (routine + extra), scans, labs, and treatment drug (AWP). Medicare reimbursed rates were applied for cost estimates. Utilization and costs were measured on per patient per month (PPPM) bases and the total cost over 6 mo for each combination. Results: Of the 42 patients included, 34 and 8 were initiated on DT and VC, respectively. Proportions of patients with extra clinic visits and hospital admissions were 79%, 15% and 75%, 13%, respectively for DT and VC. PPPM hospitalization was the lowest among the resources utilized 0.24 for DT and 0.17 for VC. A higher proportion of VC patients (75%) had a dose reduction due to drug toxicity compared with 29% of patients treated with DT (P < 0.05). Discontinuation rates were the same between both combinations (0.26). 32 patients had completed 6 mo of treatment (26 DT and 6 VC). For those DT, the mean total costs including drug and the mean monthly total costs were $157,253 and $26,209 compared to $107,240 and $17,873 for VC, respectively. The mean total costs for hospitalization were $10,562 for DT and $7,456 for VC. The mean total costs for the drug were $145,012 for DT and $97,924 for VC. Conclusions: The 6-month total cost-of-care for the treatment of first-line V-600 MM with DT was $157,253 and $107,240 for VC, mostly attributable to drug cost. In a value-based healthcare system, total 6-month cost-of-care may help distinguish between equally effective regimens.
Cost-effectiveness of various maintenance therapies based on mutation status following first-line treatment of primary epithelial ovarian cancer in the United States.
Authors: Penn Courtney , Wong Melissa , Walsh Christine S. 
Published: May 2020

e19399 Background: The recent SOLO1, PRIMA, and PAOLA trials all reported positive efficacy results, making it difficult to determine optimal upfront maintenance therapy for patients with primary, advanced ovarian cancer. We evaluated the cost-effectiveness of the maintenance strategies outlined in these trials for BRCA-positive patients, homologous-recombination deficient patients without a BRCA mutation (HRD-positive), and homologous-recombination proficient (HRD-negative) patients. Methods: Three decision analysis models were developed, one for each mutation status. We evaluated olaparib (SOLO1), olaparib/bevacizumab (PAOLA), bevacizumab alone (PAOLA), and niraparib (PRIMA) maintenance strategies. Base case 1 assessed olaparib vs olaparib/bevacizumab vs bevacizumab vs niraparib vs no maintenance therapy in BRCA-positive patients. Base cases 2 and 3 assessed olaparib/bevacizumab vs bevacizumab vs niraparib vs no maintenance therapy in HRD-positive and HRD-negative patients, respectively. Time horizon was 24 months. Costs, measured in U.S. dollars, were estimated from Medicare claims, wholesale acquisition prices, and previously published sources. Incremental cost-effectiveness ratios (ICERs) were in dollars per progression-free life-year saved (PF-LYS). One-way sensitivity analyses were performed varying drug cost and progression-free survival. Results: Assuming a willingness-to-pay threshold of $100,000/PF-LYS, none of the drug maintenance strategies could be considered cost effective compared with observation. In BRCA-positive patients (base case 1), olaparib monotherapy was the most cost-effective strategy, yielding an ICER of $181,059/PF-LYS. The third-party payer cost per 28-day supply of olaparib would need to be reduced from approximately $17,000 to $9,200 to be considered cost effective compared with observation. In HRD-positive patients (base case 2) and HRD-negative patients (base case 3), bevacizumab monotherapy was the most cost-effective option, with ICERs of $326,491/PF-LYS and $253,937/PF-LYS respectively. Conclusions: At current costs, maintenance therapy for primary ovarian cancer is not cost effective, regardless of mutation status. In BRCA-positive women, lowering the cost of olaparib may make it cost effective compared with observation.
Pharmaco-economic assessment of subcutaneous compared to intravenous trastuzumab in HER2-positive breast cancer patients: A single institution experience.
Authors: Elsamany Shereef Ahmed , Jafal Mohamed , Hassanin Fayza 
Published: May 2020

e19409 Background: Traditionally, trastuzumab is given through intravenous (IV) administration. Recently, subcutaneous (SC) trastuzumab formulation has been developed showing similar efficacy and safety with shorter administration time. This study aims to assess the pharmaco-economics of SC compared to IV trastuzumab in patients with HER2-positive breast cancer treated in a single institution in Saudi Arabia. Methods: We checked the average number of trastuzumab doses, both IV and SC, given per year in King Abdullah Medical City, Saudi Arabia. One-year pharmaco-economic analysis of either trastuzumab forms were performed separately. This analysis included direct medication price based on hospital purchasing in addition to costs of drug preparation kits, nursing administration utilities and staff working time, based on average duration of drug preparation/ administration in chemotherapy unit records. IV trastuzumab dose was calculated based on an average body weight of 80 kg. Results: On average, the total number of trastuzumab doses, both IV and SC, were 1000 doses per year. We calculated the overall cost of 1000 doses of IV compared to SC trastuzumab separately. The average costs of one dose of IV and SC trastuzumab were 2,099 and 1,619 USD, respectively. This is translated to 2,099,000 and 1,619,000 USD per year for IV and SC trastuzumab, respectively. Other costs of trastuzumab administration were 24,933 and 2,666 USD per year of IV and SC trastuzumab, respectively. IV and SC trastuzumab administration needed 2,000 and 83 working hours per year, respectively, resulting in 1,917 saving in nursing working hours per year. This is translated to 18,106 USD saving per year based on average nursing salary. IV and SC trastuzumab pharmacy preparation needed 333 and 33 working hours per year, respectively, corresponding to annual saving of 300 hours in pharmacist- working time and 10,106 USD of pharmacist salary. The overall cost of IV trastuzumab per year was 2,153,667 compared to 1,623,236 USD for SC trastuzumab which corresponds to 2,153 and 1,623 USD per dose for IV and SC trastuzumab, respectively. This is translated to 24.6% overall cost reduction with the SC formulation. Conclusions: SC trastuzumab is associated with favorable pharmaco-economic profile with considerable cost saving compared to the IV counterpart. This is coupled with significant reduction of administration time and improved convenience.
Bleeding and thrombosis outcomes in patients with acute leukemia.
Authors: Kelkar Amar Harry , Dhanarajan Asha R. , Kelkar Mona Arti , Wingard John R. 
Published: May 2020

e19501 Background: Management of acute leukemia is often complicated by acute venous thromboembolism (VTE) and bleeding. However, it is unknown which risk factors contribute to these VTE and bleeding events, how they impact survival, or whether they warrant VTE prophylaxis. Methods: A retrospective study was conducted at the University of Florida Health Shands Hospital System. The study included patients aged 18 or older with acute leukemia who received induction chemotherapy between January 2000 and December 2011. Bleeding was defined as clinically significant non-major bleeding and major bleeding per the International Society on Thrombosis and Haemostasis guidelines. VTE was defined as pulmonary embolism, deep vein thrombosis of the upper or lower extremities, or visceral vein thrombosis. Results: Of the 250 patients with acute leukemia, 65 had VTE, 60 had bleeding, and 152 had no significant VTE or bleeding. There were 27 patients with both VTE and bleeding. There were no significant differences in demographics or disease types between these three groups. There was a total of 77 VTE events and 72 bleeding events. We performed a logistic regression analysis in a mixed model to identify risk factors for VTE and bleeding, considering leukemia type, presence of infection, chemotherapy, number of comorbidities, VTE prophylaxis, and transplant as covariates. Presence of infection and number of comorbidities were significantly associated with VTE (p = 0.0094 and 0.0009, respectively). We did not find any significant risk factor associated with bleeding. Kaplan-Meier survival analysis showed a non-significant difference in survival between the non-VTE, non-bleed group and the VTE group (Logrank test, p = 0.52). In contrast, survival in the non-VTE, non-bleed group was significantly higher than the bleed group (Logrank test, p = 0.0006). The table demonstrates higher two-year survival in the non-VTE, non-bleed group (68.7%) compared to the VTE and bleed groups (54.4% and 30.3%, respectively). Conclusions: Acute leukemia patients without VTE or bleeding had significantly higher duration of survival than patients with bleeding. Patients with acute leukemia and presence of infection or multiple comorbidities may warrant greater consideration of VTE prophylaxis. [Table: see text]
Burden of relapsed/refractory (RR) acute myeloid leukemia.
Authors: Panjabi Sumeet , Hines Dionne M. , McGuiness Catherine Balderston , Yucel Emre , Yea Steven , McIver Zachariah , Wade Rolin L 
Published: May 2020

e19509 Background: To examine treatment patterns and health care costs of RRAML in the US. Methods: We identified adults with ≥ 2 outpatient or ≥ 1 inpatient claim with a diagnosis of AML from 1/1/2011 to 12/31/2017 (first AML claim = index date) using IQVIA’s fully-adjudicated Health Plan Claims Data. Continuous health plan enrolment for ≥ 12 months prior to the index date and ≥ 1-month post-index, a RRAML diagnosis on or prior to the index date, or with hematopoietic stem cell transplantation (HSCT) or chemotherapy pre-index were required. Patients were grouped by post-index treatment (high- or low-intensity chemotherapy [HIC, LIC] with and with no HSCT, HSCT only, best supportive care [BSC], or no treatment within 90 days of index [NoTx]). Costs were evaluated for 12 months following index. Results: The final sample of patients with RRAML (n = 804) were grouped by age:18-59 (n = 411; 51.2%), 60-74 (n = 318; 39.5%), and ≥75 years (n = 75; 9.3%). Treatment within the three age cohorts was: HIC (13%, 11%, 1%); LIC (27%, 38%, 52%); HIC+HSCT (14%, 7%, 0%); LIC+HSCT (2%, 3%, 0%); HSCT (9%, 9%, 0%); BSC (21%, 21%, 31%); NoTx (13%, 12%, 16%), respectively. Mean monthly costs were lowest for BSC and highest for HSCT or HIC containing treatments, irrespective of age (Table). Inpatient costs were 50 to 100% of total costs. Monthly costs across treatment/age groups were higher earlier in treatment [month 1 range: $28,627 (BSC) to $180,867 (HIC)] and declined over time [month 12 range: $2,853 (BSC) to $53,003 (HIC+HSCT)]. Conclusions: Nearly half of all patients age ≥75 years and 33% of patients < 75 years received BSC or NoTx, which highlights a significant unmet need for new treatment options. Average costs per patient, especially early in treatment are high and driven by hospital service utilization. [Table: see text]