title: Cost of skeletal-related events in European patients with solid tumours and bone metastases: data from a prospective multinational observational study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Health Economics, Amgen (Europe) GmbH, Zug, Switzerland. guy.hechmati@amgen.com
authors: G
authors: G
authors: Hechmati
authors: S
authors: S
authors: Cure
authors: A
authors: A
authors: Gouépo
authors: H
authors: H
authors: Hoefeler
authors: V
authors: V
authors: Lorusso
authors: D
authors: D
authors: Lüftner
authors: I
authors: I
authors: Duran
authors: C
authors: C
authors: Garzon-Rodriguez
authors: J
authors: J
authors: Ashcroft
authors: R
authors: R
authors: Wei
authors: P
authors: P
authors: Ghelani
authors: A
authors: A
authors: Bahl
mesh_terms: D001859:Bone Neoplasms / Q000191:economics* / Q000378:metabolism*; D003365:Costs and Cost Analysis; D005060:Europe / Q000453:epidemiology; D050723:Fractures, Bone / Q000191:economics / Q000209:etiology; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D015337:Multicenter Studies as Topic; D009362:Neoplasm Metastasis; D019637:Orthopedic Procedures / Q000191:economics; D010025:Osteoradionecrosis / Q000191:economics; D011446:Prospective Studies; D013117:Spinal Cord Compression / Q000191:economics / Q000209:etiology; D014947:Wounds and Injuries / Q000191:economics* / Q000209:etiology*