title: The economic burden of brain metastasis among lung cancer patients in the United States.
abstract: OBJECTIVE
  Brain metastases among lung cancer patients can impair cognitive and functional ability, complicate care, and reduce survival. This study focuses on the economic burden of brain metastasis in lung cancer-direct healthcare costs to payers and indirect costs to patients, payers, and employers-in the US.
  
  
  METHODS
  Retrospective study using claims data from over 60 self-insured Fortune 500 companies across all US census regions (January 1999-March 2013). Adult, non-elderly lung cancer patients with brain metastasis were evaluated over two study periods: (1) pre-diagnosis (≤30 days prior to first observed lung cancer diagnosis to ≤30 days prior to first-observed brain metastasis diagnosis) and (2) post-diagnosis (≤30 days prior to first observed brain metastasis diagnosis to end of continuous eligibility or observation).
  
  
  METHODS
  Healthcare costs to payers and resource utilization, salary loss to patients, disability payouts for payers, and productivity loss to employers.
  
  
  RESULTS
  A total of 132 patients were followed for a median of 8.4 and 6.6 months in the pre- and post-diagnosis periods, respectively. At diagnosis of brain metastasis, 21.2% of patients were on leave of absence and 6.1% on long-term disability leave. Substantial differences were observed in the pre- vs post-diagnosis periods. Specifically, patients incurred much greater healthcare utilization in the post-diagnosis period, resulting in $25,579 higher medical costs per-patient-per-6-months (PPP6M). During this period, patients missed significantly more work days, generating an incremental burden of $2853 PPP6M in salary loss for patients, $2557 PPP6M in disability payments for payers, and $4570 PPP6M in productivity loss for employers.
  
  
  CONCLUSIONS
  Type of primary lung cancer and extent of brain metastasis could not be assessed in the data. The analysis was also limited to patients with comprehensive disability coverage.
  
  
  CONCLUSIONS
  Development of brain metastasis among lung cancer patients is associated with a substantial economic burden to payers, patients, and employers.
authors.affiliation: a a Analysis Group, Inc. , Montreal , QC , Canada.
authors.forename: A
authors.initials: A
authors.lastname: Guérin
authors.affiliation: b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
authors.forename: M
authors.initials: M
authors.lastname: Sasane
authors.affiliation: a a Analysis Group, Inc. , Montreal , QC , Canada.
authors.forename: K
authors.initials: K
authors.lastname: Dea
authors.affiliation: b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
authors.forename: K
authors.initials: K
authors.lastname: Culver
authors.affiliation: a a Analysis Group, Inc. , Montreal , QC , Canada.
authors.forename: R
authors.initials: R
authors.lastname: Nitulescu
authors.affiliation: c c Analysis Group, Inc. , Boston , MA , USA.
authors.forename: E Q
authors.initials: EQ
authors.lastname: Wu
authors.affiliation: c c Analysis Group, Inc. , Boston , MA , USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Macalalad
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000191:economics* / Q000556:secondary*; D017281:Cost of Illness; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D018868:Insurance, Disability / Q000191:economics; D008175:Lung Neoplasms / Q000191:economics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Brain metastasis; Direct costs; Economic burden; Healthcare resource use; Indirect costs; Lung cancer; Productivity loss; Work loss