Pattern of Targeted Therapy Drugs and High Medical Expenditures Used in Cancer

Abstract

Introduction: Currently, treatment of cancer new innovation drugs is available. “Targeted therapies” are focused on the anti-tumor drugs specifc to inhibit the proliferation of cancer cells and affecting the blood supply to cancer cells. Despite their exisiting effcacy, costs of treatment with these drugs have been ranged as top 10 of the high medical expenditures in most hospitals. The objectives of this study were to study the pattern of using high drug costs in cancer treatment in terms of indica- tion, end of treatment and cost of treatment. Methods: This study was carried out in patients who were diagnosed as breast cancer, colorectal cancer, non-small cell lung cancer (NSCLC) and gastrointesti- nal stromal tumor (GIST) and were treated with high cost drugs (i.e., Oxaliplatin (OXP), Irinotecan (IRI), Bevacizumab (BVM), Trastuzumab (TTM), Geftinib (GFN), Erlotinib (ELN), Imatinib (IMN), and Sunitinib (SNN)), during 1st January 2009 – 31st December 2011. Patient profles were collected from medical chart records and database of hospital drug management system. Demographic data, pattern of treat- ment, clinical outcome and cost of treatment with the above targeted therapies were analyzed. Results: Data of 297 patients were collected, with the range of age of 60.8±11.2 years old. Most were under civil servant medical benefts scheme (88.2%). Treatment with TTM in breast cancer was found in 32 patients and they were treated with completed course 78%, with the cost of TTM by 717,777 Baht/ patient. Treatment with OXP in stage 3 and 4 colorectal cancer was found in 139 patients, and they received OXP until completing the course by 54.7%, with the cost of 448,540 Baht/patient. Treatment with IRI in stage 4 colorectal cancer was found 42 in patients, and they received OXP more than 12 cycles were 31.0%, with the cost of 485,390 Baht/patient. Treatment with Epidermal growth factor receptor-inhibitor (EGFR-inhibitor, i.e., GFN and ELN) in stage 4 non-small cell lung cancer was found in 52 patients, and mean duration of treatment was 7±7.6 months, with the cost of 439,017 Baht/patient. Treatment with IMN in GIST was found in 11 patients, and mean duration of treatment was 18.7±18.4 months, with the cost of 210,148 Baht/patient. Most of adverse drug effects observed in this study were hematologic disorders (i.e., anemia, neutropenia, thrombocytopenia, bicytopenia and pancytope- nia), and occured about 35.7% of the cases and 4.4% of the cases required discontinuation of the studied drugs due to adverse drug effects Conclusion: This study employed high cost studied target therapies were mostly with completed courses or until disease progression. For prescribing these expensive drugs, likelihood of incomplete course of treatment due to loss of follow-up should be of concern in order to prevent not cost-effective treatment (i.e., no better outcome can be expected despite high cost therapy given).