Health Care Resource Utilization and Costs Associated with Disease Progression in Ovarian Cancer

• Published in: Advances in therapy 2022-06, Vol.39 (6), p.2544-2561
• Main Authors: Simmons, Daniel, Blank, Stephanie V., ElNaggar, Adam C., Chastek, Benjamin, Bunner, Scott H., McLaurin, Kimmie
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Ovarian Epithelial - therapy; Cardiology; Delivery of Health Care; Disease Progression; Endocrinology; Female; Health Care Costs; Humans; Internal Medicine; Medicare; Medicine; Medicine & Public Health; Oncology; Original Research; Ovarian Neoplasms - drug therapy; Pharmacology/Toxicology; Retrospective Studies; Rheumatology; United States
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-022-02086-5

Introduction Ovarian cancer (OC) is one of the leading causes of cancer mortality among women in the United States. With the approval of first-line maintenance therapies, patients with OC experienced prolonged first-line progression-free survival. While the literature addresses some costs associated with OC, further research is needed on the costs of progression that are potentially deferred or prevented by early maintenance. The objective of this study was to capture the health care resource utilization and costs of patients with advanced OC who never received poly(ADP ribose) polymerase (PARP) inhibitor maintenance. Methods We conducted a descriptive retrospective analysis of treatment patterns and the consequences of progression through several lines of therapy (LOTs) in patients with OC, using claims from commercial and Medicare Advantage health plan members in the United States from the Optum Research Database between January 1, 2010, and April 30, 2019. Patients were required to have an index OC diagnosis (≥ 2 non-diagnostic claims). We examined up to 4 LOTs and the time between treatments. Results A total of 5498 women met the eligibility criteria. As the number of LOTs increased, the median duration of each line decreased from 137 days in LOT1 to 94 days in LOT4, and the time between lines also decreased from 245 to 0 days. Ambulatory care visits were a major driver of health care resource utilization, with a median of about 6 monthly visits during active treatment. The mean total monthly health care costs for patients with at least 2 LOTs were US$8588 (SD: $8533) before LOT2 and increased to $15,358 (SD: $21,460) during or after LOT2. Conclusions Prolonging progression-free survival after first-line treatment in patients with OC may provide the opportunity to delay or prevent later treatment, the financial toxicity felt by patients, and the economic burden to the health care system associated with progression. Plain Language Summary Ovarian cancer is a complex disease in which > 70% of patients are diagnosed with advanced disease, and one of the leading causes of cancer mortality among women in the United States. A variety of maintenance therapy options, including bevacizumab, PARP inhibitors, and PARP plus bevacizumab combination therapies, have demonstrated improvements in progression-free survival. By delaying disease progression after completion of first-line therapy, a simultaneous decrease in post-progression health care costs may be seen. T