Real-world analysis of cost, treatment patterns, and outcomes of patients with metastatic cutaneous squamous cell carcinoma in the US

ABSTRACT

Objectives

To describe real-world characteristics and treatment patterns of patients with metastatic cutaneous squamous cell carcinoma (mCSCC).

Methods

This retrospective observational study used MarketScan Commercial and Medicare Supplemental claims databases (1/1/2013–7/31/2019). Adult patients with mCSCC who initiated non-immunotherapy systemic treatment (i.e. index event) between 1 January 2014 and 31 December 2018 were assessed for treatment patterns, all-cause and CSCC-related healthcare resource utilization, costs, and mortality .

Results

Overall, 207 patients were included in the study(mean age 64.8 years, 76.3% male), 59.4% had prior radiotherapy, and 58.9% had prior CSCC-related surgery. During follow-up, 75.8%, 51.7%, and 35.7% of patients received chemotherapy, radiotherapy, and targeted therapy as first-line treatment, respectively. Cisplatin (32.9%) and carboplatin (22.7%) were the most common chemotherapy agents, and cetuximab (32.4%) was the most common targeted therapy during the first-line.

Probability of death (95% CI) at month 6, year 1, and year 2 was 24% (16–32%), 50% (40 − 59%), and 67% (56 − 75%), respectively. Average CSCC-related healthcare costs were $5,354 per person per month (PPPM), with outpatient costs being the major cost driver at 96.4% ($5,160 PPPM).

Conclusion

During 2014–2018, patients with mCSCC were commonly treated with cisplatin and cetuximab; prognosis was generally poor. These results indicate opportunity for new treatments to improve survival outcomes.

KEYWORDS:

• metastatic cutaneous squamous cell carcinoma
• treatment patterns
• healthcare utilization and costs
• mortality
• real-world data

Article highlights

• There are limited real-world data on treatment patterns and outcomes of patients with metastatic cutaneous squamous cell carcinoma (mCSCC).

• This retrospective, observational analysis of administrative healthcare claims provides a comprehensive assessment of the real-world treatment patterns, healthcare resource use and costs, and mortality of patients with mCSCC between January 2014 and July 2019, prior to the availability of immune checkpoint inhibitors.

• Cisplatin, carboplatin, paclitaxel, and fluorouracil were the most common systemic chemotherapy agents, and cetuximab was the most common targeted therapy.

• The prognosis of patients with mCSCC was generally poor (median overall survival, 12.1 months), highlighting a need at the time of the study for new therapies to improve survival outcomes in this patient population.

• Use of outpatient services were the main drivers of healthcare expenditure for patients with mCSCC, accounting for 96.4% of CSCC-related healthcare costs and averaging at $5,160 per person per month.

• This assessment of therapies in the pre-immunotherapy era can be used as a baseline for future studies on updated treatment patterns for mCSCC, including the value and outcomes of immunotherapies.

Acknowledgments

Medical writing support was provided by Sameen Yousaf, PhD, of Prime, Knutsford, UK, funded by Regeneron Pharmaceuticals, Inc., and Sanofi, according to Good Publication Practice guidelines (link). Responsibility for all opinions, conclusions, and data interpretation lies with the authors.

Declaration of interest

X Song and C Chen are employees and shareholders of Regeneron Pharmaceuticals, Inc. G Konidaris is an employee of Sanofi and may hold shares and/or stock options in the company. N Zimmerman was an employee of IBM Watson Health when this study was conducted. E Ruiz has received consulting fees from Leo Pharmaceuticals, PellePharm, Regeneron Pharmaceuticals, Inc., and Sanofi; and serves on the consulting and advisory board for Checkpoint Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Authors contributions

X Song and N Zimmerman contributed to the conception, study design, data analysis, and interpretation of results. C Chen, G Konidaris, and E Ruiz contributed to the conception, study design, and interpretation of results. All authors read and approved the final manuscript for publication. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethics

Ethical approval was not needed because this study used de-identified claims data. All database records are statistically deidentified and certified to be fully compliant with US patient confidentiality requirements set forth in the Health Insurance Portability and Accountability Act of 1996. Because this study used only deidentified patient records and did not involve the collection, use, or transmittal of individually identifiable data, this study was exempted from institutional review board approval.

Data availability statement

The data that support the findings of this study are available from Merative. Restrictions apply to the availability of these data, which were used under license for this study. Data are available under reasonable request with the permission of Merative.

Additional information

Funding

This paper was funded by Regeneron Pharmaceuticals, Inc., and Sanofi