Cost of skeletal complications from bone metastases in six European countries

Objective Patients with bone metastases or lesions secondary to solid tumors or multiple myeloma often experience bone complications (skeletal-related events [SREs]—radiation to bone, pathologic fracture, surgery to bone, and spinal cord compression); however, recent data that can be used to assess the value of treatments to prevent SREs across European countries are limited. This study aimed to provide estimates of health resource utilization (HRU) and cost associated with all SRE types in Europe. HRU data were reported previously; cost data are reported herein. Methods Eligible patients from 49 centers across Austria (n = 57), the Czech Republic (n = 59), Finland (n = 60), Greece (n = 59), Portugal (n = 59), and Sweden (n = 62) had bone metastases or lesions secondary to breast, lung, or prostate cancer, or multiple myeloma, and ≥1 index SRE (a SRE preceded by a SRE-free period of ≥ 6.5 months). SRE-related costs were estimated from a payer perspective using health resource utilization data from patient charts (before and after the index SRE diagnosis). Country-specific unit costs were from 2010 and local currencies were converted to 2010 euros. Results The mean costs across countries were €7043, €5242, €11,101, and €11,509 per radiation to bone, pathologic fracture, surgery to bone, and spinal cord compression event, respectively. Purchasing power parity (PPP)-adjusted mean cost ratios were similar in most countries, with the exception of radiation to bone. Limitations The overall burden of SREs may have been under-estimated owing to home visits and evaluations outside the hospital setting not being reported here. Conclusions All SREs were associated with substantial costs. Variation in SRE-associated costs between countries was most likely driven by differences in treatment practices and unit costs.研究目的 实体瘤或多发性骨髓瘤继发的骨转移或骨病变患者常并发骨骼并发症（骨骼相关不良事件[Skeletal-related events, SREs]——骨放疗、病理性骨折、骨手术以及脊髓压迫）；但目前可用于评估欧洲各国预防SREs治疗方案价值的相关数据仍较为有限。本研究旨在估算欧洲范围内各类SRE相关的卫生资源利用（health resource utilization, HRU）与成本：此前已有研究报道了HRU数据，本文仅报告成本相关内容。 研究方法 本研究纳入的符合入组标准的患者来自奥地利（n=57）、捷克共和国（n=59）、芬兰（n=60）、希腊（n=59）、葡萄牙（n=59）及瑞典（n=62）共49家医疗中心，这些患者均患有乳腺癌、肺癌或前列腺癌等实体瘤，或多发性骨髓瘤继发的骨转移或骨病变，且存在至少1次索引SRE（即此前有≥6.5个月的无SRE间期）。本研究从支付方视角出发，依托患者病历中索引SRE诊断前后的卫生资源利用数据，估算SRE相关成本。各国的单位成本数据取自2010年，且将当地货币统一换算为2010年欧元计价。 研究结果 各国单次事件的平均成本分别为：骨放疗7043欧元、病理性骨折5242欧元、骨手术11101欧元、脊髓压迫11509欧元。经购买力平价（purchasing power parity, PPP）调整后的平均成本比值在多数国家中趋于一致，仅骨放疗组存在例外。 研究局限 由于本研究未纳入家庭访视及院外诊疗场景下的相关数据，SRE的整体疾病负担或存在低估。 研究结论 各类SRE均与高额医疗成本相关，各国间SRE相关成本的差异大概率源于诊疗实践模式与单位成本的不同。