OBJECTIVES

: To describe hospital resource utilization and costs for the management of patients with unresectable/locally advanced or metastatic esophageal cancer, eligible for a first-line treatment.

METHODS

: An observational retrospective cohort study was conducted using the French exhaustive hospital discharge database (PMSI). Study population was identified through an algorithm based on expert inputs and combining criteria as ICD-10, surgery codes, treatment duration and stays in palliative care. Adults hospitalized with an ICD-10 code of esophageal cancer (C15 excluding C152) in 2015 and 2016 were included. Patients with a surgery were excluded, except those having a metastasis (C77-C79). Patient with a systemic anti-cancer therapy (SACT) less than 2 months or with at least one stay in palliative care were excluded, assuming weakness to receive SACT. Treatment was defined as chemotherapy (Z511) and first-line treatment was defined as the 0-6 months period after patient identification based on literature.

RESULTS

: Overall, 19,582 patients with unresectable/locally advanced or metastatic esophageal cancer were identified; 9,799 were considered eligible to receive a treatment. Among them, 4,032 received at least one chemotherapy session during the study period and 3,962 were treated in first line. These patients were aged 65.2±9.6 and 81.8% were men. 2-year mortality rate was 23%. 59,009 hospital stays were observed and distributed as 47% related to chemotherapy, 33% to radiotherapy and 20% for other reasons. Among chemotherapy sessions, 10% were associated with expensive drugs funded on top of DRG list. Chemotherapy and radiotherapy sessions were day hospitalization in majority and costed in average respectively 633.68±994.93€ and 270.41±351.05€ from NHI perspective and 1,038±684€ and 209±422€ from collective perspective. Transportation cost was estimated at 35.17€/session.

CONCLUSIONS

: This study showed that only 50% of patients with unresectable/locally advanced or metastatic esophageal cancer were eligible to receive a treatment and only 20% received at least one chemotherapy session.