Healthcare-resource utilization associated with radiation to bone across eight European countries: Results from a retrospective study

Abstract

Background: Bone metastases and lytic lesions due to multiple myeloma are common in advanced cancer and can lead to debilitating complications (skeletal-related events [SREs]), including requirement for radiation to bone. Despite the high frequency of radiation to bone in patients with metastatic bone disease, our knowledge of associated healthcare resource utilization (HRU) is limited.

Methods: This retrospective study estimated HRU following radiation to bone in Austria, the Czech Republic, Finland, Greece, Poland, Portugal, Sweden and Switzerland. Eligible patients were ≥ 20 years old, had bone metastases secondary to breast, lung or prostate cancer, or bone lesions associated with multiple myeloma, and had received radiation to bone between 1 July 2004 and 1 July 2009. HRU data were extracted from hospital patient charts from 3.5 months before the index SRE (radiation to bone preceded by a SRE-free period of ≥ 6.5 months) until 3 months after the last SRE that the patient experienced during the study period.

Results: In total, 482 patients were included. The number of inpatient stays increased from baseline by a mean of 0.52 (standard deviation [SD] 1.17) stays per radiation to bone event and the duration of stays increased by a mean of 7.8 (SD 14.8) days. Outpatient visits increased by a mean of 4.24 (SD 6.57) visits and procedures by a mean of 8.51 (SD 7.46) procedures.

Conclusion: HRU increased following radiation to bone across all countries studied. Agents that prevent severe pain and delay the need for radiation have the potential to reduce the burden imposed on healthcare resources and patients.

Keywords: Bone metastases; Bone pain; Health resource utilization; Radiation to bone; Skeletal-related event.

Fig. 1

Study design and data collection for patients with (a) one SRE and (b) multiple SREs. ^aTo ensure lack of carry-over of HRU from a previous SRE that occurred before the 3.5-month pre-SRE period, a clean window of an additional 3 months without an SRE was required. ^bFor multiple SREs, the post-index SRE observational period was extended to 3 months following the last observed SRE. To ensure that any HRU used to diagnose the SRE is included in the HRU burden for the SRE, there is a 2-week diagnosis period immediately before the SRE. Estimate of HRU associated with SRE = (post-SRE period + diagnosis period) − baseline period. Data were adjusted to allow for the different lengths of the baseline and post-baseline periods. When multiple SREs were observed at the same anatomical site and within a 21-day window, HRU was attributed to the index SRE. When multiple SREs were observed at the same anatomical site but outside a 21-day window, or multiple SREs were observed at different anatomical sites on the same or different days, the expert panel attributed HRU to the respective SRE. HRU, healthcare resource utilization; SRE, skeletal-related event.

Fig. 2

Mean change from baseline in (a) the number and (b) the duration of inpatient stays per radiation to bone event. Data are shown as mean (+ standard deviation). N, number of patients enrolled from each country.

Fig. 3

Mean change from baseline in the number of (a) outpatient visits, (b) procedures and (c) day-care visits per radiation to bone event. Data are shown as mean (+ standard deviation). N, number of patients enrolled from each country.

Fig. 4

Mean change from baseline in the number of (a) outpatient visits and (b) procedures per radiation to bone event by the most common provider types or procedures. Data are shown as mean (+ standard deviation). N, number of patients enrolled from each country.