title: Systemic therapy for colorectal cancer: patterns of chemotherapy and biologic therapy use in nationally representative US claims database.
abstract: BACKGROUND
  Treatment strategies for colorectal cancer (CRC) are highly variable. The aim of this study is to examine the patterns of chemotherapy and biologic therapy use for CRC patients in a national medical claims database.
  
  
  METHODS
  A retrospective and observational analysis was performed using the i3 Innovus claims database to identify healthcare services consumed by patients aged 18 years and older, diagnosed with CRC between 1 January 2005 and 30 June 2009 in commercial health plans.
  
  
  RESULTS
  Of 9,876 subjects diagnosed with CRC, fluorouracil (23.5 %) and capecitabine (10.0 %) were the dominant first-line monotherapies, followed by bevacizumab (3.2 %) and oxaliplatin (2.9 %). The most common combination regimen at first line and first and second line was FOLFOX (fluorouracil, leucovorin, and oxaliplatin; more than 25 %). The combinations FOLFIRI (fluorouracil, leucovorin, and irinotecan) plus bevacizumab (14.2 %) and FOLFOX plus bevacizumab (13.9 %) were significantly more frequent in third and successive lines of CRC therapy than other regimens (χ(2) = 191.2; P < 0.01). Additionally, the average annualized cost of CRC treatment for all patients was $US66,452, and the adjusted analysis demonstrated that patients receiving FOLFOX-A (FOLFOX + avastin) or FOLFIRI-A (FOLFIRI + avastin) had higher costs for CRC treatment.
  
  
  CONCLUSIONS
  With the exception of a sizeable portion of patients on monotherapy, the treatment patterns for CRC were largely consistent with National Comprehensive Cancer Network (NCCN) guidelines.
authors.affiliation: Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ, USA.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Seal
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Shermock
authors.forename: Jinma
authors.initials: J
authors.lastname: Ren
authors.forename: Charlie
authors.initials: C
authors.lastname: Kreilick
authors.forename: Susan
authors.initials: S
authors.lastname: Boklage
authors.forename: Satish
authors.initials: S
authors.lastname: Valluri
authors.forename: Syam
authors.initials: S
authors.lastname: Sarma
authors.forename: Carl V
authors.initials: CV
authors.lastname: Asche
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000068258:Bevacizumab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D016208:Databases, Factual; D017048:Health Care Costs; D006801:Humans; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab