Direct Health Care Costs of Metastatic Ovarian Cancer in a Commercially-Insured Population: A Retrospective Database Analysis
Chin, Lauren Mika
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Background: Ovarian cancer is the 10th most common type of cancer and the 5th leading cause of cancer death among women in the United States (U.S.). The majority of incident ovarian cancer cases are diagnosed in individual less than 65 years of age, but little evidence exists regarding the economic burden of ovarian cancer in this age group. Objectives: The primary objectives of this study were to estimate the mean annual all-cause direct total costs of metastatic ovarian cancer, to compare costs of metastatic ovarian cancer patients to costs in patients without cancer (i.e. controls), and to identify factors associated with high annual all-cause direct total costs (i.e., individuals among the upper quintile) of metastatic ovarian cancer. Methods: We conducted a retrospective claims analysis using the Truven Health MarketScan® Commercial Claims and Encounters Database. Metastatic ovarian cancer patients were identified based on having a combination of diagnosis codes for a secondary malignancy and ovarian cancer (earliest date of secondary malignancy defined as the index date) between January 1, 2011 through December 31, 2015, ≥18 years old on the index date, ≥12 months of continuous enrollment prior to the index date, and ≥1 month of continuous enrollment after the index date. Controls were randomly selected and matched to metastatic ovarian cancer patients based on age, region, index date, number of months of continuous enrollment after the index date, and propensity score. Mean annual all-cause total costs and ovarian cancer-related total costs were estimated and compared for each cohort by using the Kaplan-Meier sample average technique to account for censoring after the index date. Patient demographic and clinical characteristics were evaluated using a logistic regression model to determine if any variables were significantly associated with the upper quintiles of annual all-cause total costs and ovarian cancer-related total costs. Results: The mean (95% CI) annual all-cause total costs in the 12-month post-index period were $149,133 ($144,873-153,330) for metastatic ovarian cancer patients and $36,566 ($33,542-39,548) for controls; the resulting mean (95% CI) difference in annual all-cause total costs was $112,567 ($109,589-115,649). The mean (95% CI) annual ovarian cancer-related total costs in the 12-month post-index period were $91,855 ($87,078-96,595) for metastatic ovarian cancer patients and $0 ($0) for controls. No patient characteristics were found to be significantly associated with the upper quintiles of annual all-cause total costs and ovarian cancer-related total costs. Conclusions: Patients less than 65 years old (i.e. the working age population) with metastatic ovarian cancer have significantly higher costs compared to those without cancer. Given that the majority of ovarian cancer patients are diagnosed at less than 65 years of age, these findings contribute to the understanding of the burden of illness in a patient population where little evidence currently exists on the economic consequences of the disease.