title: Treatment Patterns, Costs, and Survival among Medicare-Enrolled Elderly Patients Diagnosed with Advanced Stage Gastric Cancer: Analysis of a Linked Population-Based Cancer Registry and Administrative Claims Database.
abstract: OBJECTIVE
  To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy.
  
  
  METHODS
  This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) ≥65 years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemo-therapy agent.
  
  
  RESULTS
  In total, 2,583 patients met the inclusion criteria. The mean age at index was 74.8±6.0 years. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) 70,808±56,620. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001).
  
  
  CONCLUSIONS
  The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Karve
authors.affiliation: Eli Lilly and Company, Windlesham, Surrey, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Lorenzo
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Astra M
authors.initials: AM
authors.lastname: Liepa
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Hess
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Kaye
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Calingaert
keywords: Claims data; Costs; Gastric cancer; Survival; Treatment patterns