Costs of medical care for mesothelioma

Our plain-English summary of Costs of medical care for mesothelioma, by E. Borrelli, Z. Babcock, S. Kogut (Rare Tumors, 2019).

The study

• Authors: E. Borrelli, Z. Babcock, S. Kogut
• Journal: Rare Tumors
• Published: 2019;11:2036361319863498
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare and devastating form of cancer with an increasing economic burden. We sought to describe the direct cost burden of mesothelioma to the US health system. A systematic literature review was performed to locate published estimates of the medical cost of mesothelioma. In addition, we performed an analysis of hospital discharge data from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We also reviewed publicly available legal settlements. We found that published estimates of the cost of medical care for mesothelioma are sparse, and differ with respect to nation, timeframe, and types of cost included. For the year 2014 in the United States, we estimated a mean cost per mesothelioma hospitalization of US$24,124 (95% confidence interval: US$20,819-US$28,983) and a total cost for hospital care of US$44,214,835. In conclusion, we found that reports describing the direct medical cost of care for mesothelioma in the United States are lacking, yet the per-patient cost of care is substantial, as evidenced by analyses of inpatient care and legal settlements.

In plain English

This study estimated the direct medical costs of mesothelioma. The authors combined a systematic literature search (nine relevant publications), an analysis of 2014 US national hospital discharge data, a chemotherapy cost estimate, and a review of 20 US legal cases. The hospital data covered an estimated 1,675 stays with a primary diagnosis of mesothelioma, costing US$41,709,687 in total, or US$24,901 per stay on average (95% confidence interval US$20,819 to US$28,983). Stays with a mesothelioma-related procedure averaged US$29,344 (95% CI US$24,349 to US$34,340), compared with US$10,263 (95% CI US$8,579 to US$11,946) for stays without one. Using 2017 wholesale drug prices, six cycles of pemetrexed plus cisplatin were estimated at US$38,779, or US$87,741 with bevacizumab added; these excluded facility costs and side-effect management. Awards for medical expenses in the legal cases ranged from US$113,594 to US$900,000. The authors concluded that cost data are lacking and that the total US cost burden is limited by the disease's low prevalence. They excluded indirect costs, found no published US outpatient cost data, and noted that one patient can have several hospital stays.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cost study with several parts: a systematic literature review, an analysis of US national hospital discharge data, a chemotherapy cost estimate, and a review of published legal settlements
• Who was studied: 1,675 weighted US hospital discharges in 2014 with a primary diagnosis of mesothelioma, from the National Inpatient Sample (Healthcare Cost and Utilization Project). Stays were identified by ICD-9 codes for malignant neoplasm of the pleura. The study also covered published cost studies from several countries and 20 US legal cases.
• Exposure: Not an exposure study: it measured the cost of care for mesothelioma. Of the 20 legal cases reviewed, 18 patients had occupational asbestos exposure and 2 had secondary exposure. No fiber types were reported.
• Main results:
  • The literature review identified nine relevant articles, abstracts and presentations on the direct medical cost of mesothelioma.
  • Total US hospital inpatient cost for stays with a primary diagnosis of mesothelioma in 2014: US$41,709,687.
  • Mean cost per hospitalization: US$24,901 (95% CI US$20,819 to US$28,983). Mean length of stay: 7.7 days (95% CI 7.0 to 8.4).
  • Hospitalizations with a mesothelioma-related procedure had a mean cost of US$29,344 (95% CI US$24,349 to US$34,340). Hospitalizations without such a procedure averaged US$10,263 (95% CI US$8,579 to US$11,946).
  • By region, the Northeast had the highest mean cost per episode, US$33,396 (95% CI US$23,045 to US$43,748). The Midwest had the lowest, US$18,206 (95% CI US$15,523 to US$20,888).
  • By age, patients aged 45 to 64 had the highest mean cost per episode, US$30,845 (95% CI US$22,431 to US$39,258). Patients aged 85 and older had the lowest, US$15,534 (95% CI US$12,717 to US$18,352).
  • Mean cost per procedure ranged from US$16,089 for drainage of the pleural cavity (95% CI US$12,883 to US$19,296) to US$62,408 for pneumonectomy, NOS (95% CI US$48,385 to US$76,431).
  • Medicare was responsible for about 70% of these inpatient costs.
  • Six cycles of pemetrexed plus cisplatin were estimated to cost US$38,779 at 2017 wholesale acquisition prices, assuming a 72 kg male patient. This excludes facility costs and management of side effects.
  • Adding bevacizumab raised the estimated chemotherapy regimen cost to US$87,741.
  • In the 20 legal cases reviewed, awards for total medical expenses ranged from US$113,594 to US$900,000.
• The authors' conclusion: The authors concluded that mesothelioma's cost burden to the US health care system is limited by its relatively low prevalence and that data on average costs of care are lacking. They called for more research on total treatment costs, including outpatient care, new medicines, and indirect and intangible costs.
• Limitations the authors state:
  • The study took a health system perspective and did not include indirect or intangible costs.
  • The authors did not adjust for cost inflation.
  • The authors could not find published information on the cost of outpatient care for mesothelioma in the United States.
  • Hospital discharges are not an incidence rate, because one patient may have several hospital stays in a year.
  • The chemotherapy cost estimates do not include facility costs or management of toxicity.
  • In the legal cases, the authors often could not separate the cost of care from patients' out-of-pocket spending, and the cases generally did not explain how the amounts were calculated.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Systematic Review, confidence interval.

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