Lincy Lal, PhD, Optum, Eden Prairie, MN, discusses results from a study describing the utilization of integrated clinical and claims data to evaluate treatment patterns, resource utilization, and total costs of care during therapy for patients with newly diagnosed metastatic and non-metastatic renal, bladder, and testicular cancers.
These results were presented at the virtual 2021 ASCO Genitourinary Cancers Symposium.
Transcript: Hello. My name is Lincy Lal. Thank you for this opportunity to talk about our research, which was presented at the 2021ASCO GU Cancer Symposium. It is based on work we have conducted for our parent company, which is UnitedHealth Group. We are helping the Pharmacy and Therapeutics Committee to evaluate regimens in their cancer guidance program.
Specifically, this work focuses on treatment patterns and outcomes in patients diagnosed with genitourinary cancers that links the clinical information from the prior authorization data with their patient claims data.
The integration of the clinical and claims data allows for the examination of outcomes and characteristics, which is essential for real-world evidence generation and clinical decision-making.
We used the clinical data that is gathered as part of the prior authorization program and integrated with our claims data to evaluate treatment patterns, resource utilization, specifically hospitalization, and total cost of care. This research specifically focuses on three types of cancer: renal cancer, bladder cancer, and testicular cancer.
The PA process itself is a web-based tool that captures the clinical data. The physician selects the evidence-based treatment from a menu after answering a series of questions, which is based off the NCCN guidelines. Then the system ensures coverage. The patient and provider receives approval within seconds, in many cases.
Once the approval is done, that data is collected and given to us in the research setting. Specifically for this study, we are looking at commercially insured patients with a GU cancer diagnosis from February of 2016 to December of 2019.
The linked data analyzed a series of clinical information that included the metastatic status of the patient, the cancer type, the treatment line, and the regimen. From the claims side, we incorporated treatment duration, resource utilization, total cost, and the actual received regimen.
The line of therapy was determined from the start of the first regimen drug and ended when the treatment discontinued, the patient died or disenrolled from the plan, or it was considered a censored line if none of the events for the ending occurred. Drug additions or switches incremented the LOT, while single-drug discontinuation did not.
We had 3736 patients who met the criteria, of whom 13% had a censored line. 25% of the patients were in a metastatic setting, while 75% were in the early stage adjuvant/neoadjuvant treatment line. 60% of the population were above 55 years of age. 85% were male.
The mean durations of treatment in the early stage adjuvant/neoadjuvant space range from 50 days for bladder to 119 days for renal, while the median duration for the metastatic treatment line ranged from 71 days in the testicular cancer to 82 days for renal cancer. Inpatient admissions were high at 31% for renal cancer.
Also, the most expensive treatment in both the metastatic and adjuvant/neoadjuvant setting also occurred in renal cancer, in the range of 192,000 for the adjuvant/neoadjuvant setting and 136,000 for the metastatic setting, respectively. In terms of the percentage of patients who had inpatient admissions, it was also highest for the renal cancer.
In conclusion, this method of linking clinical and claims information provides information on the effectiveness of these regimens that can be taken in consideration as a P&T decides what could be the preferred regimens for each cancer. In addition to safety and efficacy, effectiveness information can be combined to make a determination on what would be best for the patient.
I would also add some of the limitations of this study was around the fact that we only included injectable drugs into the portal system at this point for prior authorization. Patients only on oral agents are not included.
At the same time, this study only focused on commercially insured patients. However, after December 2019, we have also started including Medicare Advantage patients into the prior authorization system, so that limitation has been overcome. Thank you.
Lal L, Elliott C, Korrer S, et al. Evaluation of treatment patterns and outcomes in patients diagnosed with genitourinary (GU) cancers with linked claims plus prior authorization data. Presented at: the virtual 2021 ASCO Genitourinary Cancers Symposium; February 11-13, 2021. Abstract #284.
Dr Lal reports employment by Optum and institutional research funding from Astellas; AstraZeneca; Celgene; Clovis Oncology; Foundation Medicine; Genentech/Roche; Incyte; Kite, a Gilead company; Lilly; Novartis; Sandoz; and Vertex.
