Cost of skeletal-related events in European patients with solid tumours and bone metastases: data from a prospective multinational observational study

Abstract

Objectives:

Patients with bone metastases often experience skeletal-related events (SREs: radiation or surgery to bone, pathologic fracture, and spinal cord compression). This study examined health resource utilization and costs associated with SREs.

Methods:

Data presented are from the European cohort (Germany, Italy, Spain, and the UK) of patients with solid tumours enrolled in a multi-national, prospective, observational study in patients with solid tumours or multiple myeloma. Patients with Eastern Cooperative Oncology Group score 0–2 and life expectancy ≥6 months, who experienced an SRE up to 97 days before enrolment, were eligible. Health resource utilization associated with SREs (including number/length of inpatient stays, numbers of procedures and outpatient visits) were collected through chart review for up to 97 days before enrolment and prospectively during follow-up. Country-specific cost calculations were performed.

Results:

In total, 478 eligible patients contributed 893 SREs to this analysis. Radiation to bone occurred most frequently (66% of total). Spinal cord compression (7%) and surgery to bone (10%) were the least common events, but most likely to require inpatient stays. The most costly SREs were also spinal cord compression (mean per SRE across countries, €4884–€12,082) and surgery to bone (€3348–€9407). Inpatient stays were the main cost drivers.

Limitations:

Health resource utilization used to calculate the costs associated with SREs may have been under-estimated as a result of exclusion of patients with low performance status or life expectancy; unavailable information and exclusion of resource consumption associated with pain. Thus, the estimate of associated costs is likely to be conservative.

Conclusions:

SREs result in considerable health resource utilization, imposing a substantial financial burden driven by inpatient stays. Treatments that prevent/delay SREs may help ease this burden, thereby providing cost savings across European healthcare systems.

Keywords::

• Bone metastasis
• Skeletal-related event
• Solid tumour
• Healthcare resource
• Cost

Transparency

Declaration of funding

This work was supported by Amgen Inc.

Declaration of financial/other interests

G. Hechmati is an employee of Amgen (Europe) GmbH and holds stock. S. Cure and A. Gouépo are employees of Optuminsight, UK. H. Hoefeler has served as an advisor to Amgen.

V. Lorusso has no conflicts of interest to declare. D. Lüftner has been a speaker for Amgen and participated in Advisory Boards. I. Duran has participated in advisory boards and lectures for Amgen and Novartis. C. Garzon-Rodriguez has participated in advisory boards for Amgen.

J. Ashcroft has participated in advisory boards for Novartis and Amgen. R. Wei is an employee of Amgen Inc. and holds stock. P. Ghelani is employed by Ovatech Solutions and has undertaken contracts with Amgen Limited. A. Bahl has participated in advisory boards and presented lectures for Amgen and Novartis.

Acknowledgements

The authors thank Dr Steven Inglis (PhD) from Oxford PharmaGenesisTM Ltd (UK) who provided medical writing support. Funding for this support was provided by Amgen Europe (GmbH).