Effects of skeletal complications on total medical care costs in patients with bone metastases of solid tumors

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Abstract
8094 Background: Patients with bone metastases of breast, lung, and prostate cancer often experience skeletal-related complications including pathological fracture, spinal cord compression, hypercalcemia, or pain requiring surgery, radiotherapy, or opioid analgesics (collectively, skeletal-related events [SREs]). Effects of SREs on total medical-care costs have not been compared across patients with different tumor types. Methods: We used a US health insurance claims database (7/94–6/02) to quantify the impact of SREs on total medical-care costs in patients with bone metastases of various solid tumors. Subjects included in this analysis had ≥2 encounters with a diagnosis of primary breast, lung, or prostate cancer and ≥2 encounters with a diagnosis of metastases to bone. For each tumor type, Kaplan-Meier estimated medical-care costs were compared for propensity-matched samples of patients with SREs versus without SREs. Results: We identified 1702 patients with bone metastases of breast (n=617), lung (n=543), and prostate cancer (n=542), of whom 52% (breast and prostate) to 55% (lung) experienced at least one SRE during the observation period (mean 6.0 mos [lung] to 15 mos [breast]). After matching for age, gender, and comorbidities using propensity score, there were 201, 162 and 181 pairs of SRE/no SRE patients with breast, lung, and prostate cancer, respectively. In SRE patients, costs of SRE treatment ranged from $9,480 (95%CI $7,625-$11,374) in lung to $13,940 ($11,240-$16,856) in breast cancer. Differences (SRE vs no SRE) in total costs (SRE treatment and other care) ranged from $20,792 ($4,829-$36,475) in prostate to $48,173 ($19,068-$77,684) in breast cancer. Median survival was greater in SRE vs no SRE patients in lung cancer (p=.048); there was a similar trend in breast and prostate cancers. After adjusting for differences (SRE vs no SRE) in survival, differences (SRE vs no SRE) in total costs ranged from $18,051 in prostate to $43,548 in breast cancer. Conclusions: Costs of SREs in patients with solid tumors and bone metastases are substantial across tumor types and may be greatest in breast cancer. Treatments which prevent SREs, such as intravenous bisphosphonates, may reduce these costs.

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