Treatment Patterns, Clinical Outcomes, Health Care Resource Use and Costs in Older Adults with Malignant Pleural Mesothelioma in the United States
Author(s)
Himani Aggarwal, MPhil, PhD1, Ashwini Arunachalam, MPH, BDS1, Jae Min, PhD, BA1, Yu-Han Kao, PhD1, Haidong Feng, MPH, MS1, Danmeng Huang, PhD1, Gloria N. Odonkor, MS, MPH2;
1Merck & Co., Inc., Rahway, NJ, USA, 2University of Texas at Austin, Austin, TX, USA
1Merck & Co., Inc., Rahway, NJ, USA, 2University of Texas at Austin, Austin, TX, USA
Presentation Documents
OBJECTIVES: Malignant pleural mesothelioma (MPM) is a rare malignancy of the lungs typically attributed to asbestos exposure and associated with poor survival. The standard of care for advanced MPM has been platinum-based chemotherapy until the recent approval of immunotherapy in 2020. To understand the disease burden in patients with MPM, this study examined treatment patterns, clinical outcomes, health care resource use (HCRU) and costs in these patients.
METHODS: This retrospective study utilized the Surveillance, Epidemiology, and End Results (SEER)-Medicare database in the United States to identify patients ≥65 years who had initiated first-line therapy (1L, index event) for distant MPM between 2007 and 2019. Patients were required to have continuous Medicare enrollment from the diagnosis date to at least 3 months post index and at least 6 months follow-up period. Patient characteristics were described in the 12-month pre-index period and treatment patterns, clinical outcomes, HCRU and costs to the payor in the follow-up period. Kaplan-Meier methods were used for real-world time-to-treatment-discontinuation (rwTTD) and overall survival (OS).
RESULTS: Among 554 MPM patients with 1L treatment, median age was 74 years, majority were White (95.0%) and male (73.7%). Most common 1L treatments were platinum-pemetrexed (75.6%), pemetrexed monotherapy (8.5%) and bevacizumab-platinum-pemetrexed therapy (8.1%). Platinum-pemetrexed (25.0%) and gemcitabine (25.0%) were the most common second-line and third-line therapies, respectively. The median rwTTD and OS for 1L were 5.3 months and 16.3 months, respectively. On per-patient-per-month basis, mean all-cause (and MPM-related) HCRU and costs during the follow-up period were 0.04 (0.03) inpatient admissions, 1.74 (0.85) outpatient visits, 0.18 (0.08) emergency room visits and $11,432 ($5,640) total costs.
CONCLUSIONS: The study highlights significant clinical and economic burden in advanced MPM patients who received 1L chemotherapy and underscores the need for more effective therapies to improve outcomes. Further research into outcomes related to recent immunotherapy is warranted.
METHODS: This retrospective study utilized the Surveillance, Epidemiology, and End Results (SEER)-Medicare database in the United States to identify patients ≥65 years who had initiated first-line therapy (1L, index event) for distant MPM between 2007 and 2019. Patients were required to have continuous Medicare enrollment from the diagnosis date to at least 3 months post index and at least 6 months follow-up period. Patient characteristics were described in the 12-month pre-index period and treatment patterns, clinical outcomes, HCRU and costs to the payor in the follow-up period. Kaplan-Meier methods were used for real-world time-to-treatment-discontinuation (rwTTD) and overall survival (OS).
RESULTS: Among 554 MPM patients with 1L treatment, median age was 74 years, majority were White (95.0%) and male (73.7%). Most common 1L treatments were platinum-pemetrexed (75.6%), pemetrexed monotherapy (8.5%) and bevacizumab-platinum-pemetrexed therapy (8.1%). Platinum-pemetrexed (25.0%) and gemcitabine (25.0%) were the most common second-line and third-line therapies, respectively. The median rwTTD and OS for 1L were 5.3 months and 16.3 months, respectively. On per-patient-per-month basis, mean all-cause (and MPM-related) HCRU and costs during the follow-up period were 0.04 (0.03) inpatient admissions, 1.74 (0.85) outpatient visits, 0.18 (0.08) emergency room visits and $11,432 ($5,640) total costs.
CONCLUSIONS: The study highlights significant clinical and economic burden in advanced MPM patients who received 1L chemotherapy and underscores the need for more effective therapies to improve outcomes. Further research into outcomes related to recent immunotherapy is warranted.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO176
Topic
Clinical Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology