Resource utilization in patients with brain metastases managed with best supportive care, radiotherapy and/or surgical resection: a Markov analysis

Abstract

Objective: In spite of the large number of patients and increasing financial pressure on health care budgets worldwide, limited data on resource utilization after diagnosis of brain metastases are available.

Methods: Prospective data were collected on all patients diagnosed with brain metastases during a time period of 2 years (n = 53). Treatment was best supportive care (BSC), primary radiotherapy (RT) and/or surgical resection. Eighty-five percent of patients had active extracranial disease. Costs were calculated from the hospital and nursing home's point of view.

Results: Overall, 11,532 patient days were analyzed. Treatment per patient amounted to 0.8 courses of whole-brain RT, 0.2 neurosurgical procedures, 0.1 radiosurgical procedures and 1.3 cycles of chemotherapy. Median survival in the BSC, RT and neurosurgery groups was 1.4, 4.6 and 11.0 months, respectively. Chemotherapy was associated with longer median survival. Four percent of the remaining lifetime was spent in nursing homes and 8% within hospitals. Forty-three percent of all hospital days and 47% of deaths were related to non-neurologic causes. The total cost per patient was 24,649 EUR (34,841 USD) and the corresponding cost per life year was 43,955 EUR (62,130 USD). Hospital care was the main cost factor.

Conclusions: A considerable amount of resources is utilized in this patient group. Better tools for avoiding overtreatment and selecting patients for appropriate therapy are needed to achieve maximum value for money.