Why carry out this study?
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Moisturizers are used for skin disorders caused as an adverse reaction of molecular targeted therapies in patients with cancer. |
Cost and use of moisturizers are not clear in clinical practice. |
This study was to analyze the use and costs of moisturizers in patients treated with molecular targeted therapies, using a health insurance claims database. |
What was learned from the study?
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Moisturizer prescription timing, duration, and volume were inconsistent. |
The moisturizer costs were only a small proportion of the total medical costs required for cancer treatment, and use of moisturizers may contribute to continuation of molecular targeted therapy (MTT) treatment. |
Introduction
Methods
Data Source
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not treated with the defined MTTs during the patient selection period;
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prescribed at least one moisturizer (heparinoids, petrolatum, urea) within the pre-index period;
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prescribed at least one MTT within the pre-index period;
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not continuously observed in the database during the follow-up period (patients must have had at least one medical claim each quarter within the follow-up period);
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age < 18 years at the index date; and
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prescribed MTT drugs from more than one MTT category at the index date.
Patient Characteristics
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age at the index date;
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sex;
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cancer type (International Classification of Diseases version 10 (ICD-10) codes: C00–C96);
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type of MTT being used; and
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type of moisturizer [Anatomical, Therapeutic, Chemical Classification (ATC) codes: C05B0 (heparinoid), V07A0 (petrolatum), and D02A0 (urea)].
Statistical Analysis
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number of days for which a patient was treated with MTT during the follow-up period;
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total number of days for which a patient used moisturizers during the follow-up period, total amount (g) of prescribed moisturizers, and the number and proportion of patients who were prescribed moisturizers (by month);
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total number of days for which a patient used moisturizers after the washout period, total amount (g) of prescribed moisturizers, and the number and proportion of patients who were prescribed moisturizers during the follow-up period;
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whether treatment with radiotherapy was performed during the follow-up period (according to the presence of the management/implementation fee for radiotherapy, M001) and, if so, the number of days a patient received treatment; and
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total medical costs 6 months and 12 months from the index date, and costs of outpatient visits, hospitalization, prescribed drugs, and radiotherapy (exchange rate of USD 1 = JPY 114.59 as of April 2019).
Results
Patient Demographics
Overall | All (no moisturizer) | All (with moisturizer) | Heparinoid | Petrolatum | Urea | Combination | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
78,190 | 50,284 | 64.3% | 27,906 | 35.7% | 20,265 | 72.6% | 3960 | 14.2% | 2,952 | 10.6% | 729 | 2.6% | ||
Sex, n (%) | ||||||||||||||
Male | 36,041 | 46.1% | 22,805 | 45.4% | 13,236 | 47.4% | 9588 | 47.3% | 1841 | 46.5% | 1481 | 50.2% | 326 | 44.7% |
Female | 42,149 | 53.9% | 27,479 | 54.7% | 14,670 | 52.6% | 10,677 | 52.7% | 2119 | 53.5% | 1471 | 49.8% | 403 | 55.3% |
Age | ||||||||||||||
Mean (SD) | 65.07 (12.25) | 64.71 (12.50) | 65.73 (11.76) | 65.57 (11.67) | 66.15 (12.34) | 66.41 (11.47) | 65.13 (12.05) | |||||||
95% CI | 64.99–65.16 | 64.60–64.82 | 65.59–65.87 | 65.41–65.73 | 65.77–66.54 | 65.99–66.82 | 64.26–66.01 | |||||||
Min, Max | 18, 99 | 18, 98 | 18, 99 | 18, 97 | 18, 99 | 18, 94 | 18, 90 | |||||||
Median | 67 | 66 | 67 | 67 | 68 | 68 | 66 | |||||||
Age category (years), n (%) | ||||||||||||||
18–34 | 1358 | 1.7% | 980 | 2.0% | 378 | 1.4% | 255 | 1.3% | 78 | 2.0% | 30 | 1.0% | 15 | 2.1% |
35–44 | 3970 | 5.1% | 2726 | 5.4% | 1244 | 4.5% | 923 | 4.6% | 168 | 4.2% | 115 | 3.9% | 38 | 5.2% |
45–54 | 9099 | 11.6% | 6102 | 12.1% | 2997 | 10.7% | 2212 | 10.9% | 416 | 10.5% | 302 | 10.2% | 67 | 9.2% |
55–64 | 18,552 | 23.7% | 12,023 | 23.9% | 6529 | 23.4% | 4778 | 23.6% | 866 | 21.9% | 691 | 23.4% | 194 | 26.6% |
65–74 | 27,301 | 34.9% | 17,144 | 34.1% | 10,157 | 36.4% | 7483 | 36.9% | 1375 | 34.7% | 1049 | 35.5% | 250 | 34.3% |
75– | 17,910 | 22.9% | 11,309 | 22.5% | 6601 | 23.7% | 4614 | 22.8% | 1057 | 26.7% | 765 | 25.9% | 165 | 22.6% |
Overall | All (no moisturizer) | All (with moisturizer) | Details of moisturizer | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Heparinoid | Petrolatum | Urea | Combination | ||||||||||
MTT group (at the index date), n (% of usage in the MTT group) | |||||||||||||
VEGF inhibitor | 19,728 | 11,804 | 59.8% | 7924 | 40.2% | 6060 | 30.7% | 869 | 4.4% | 782 | 4.0% | 213 | 1.1% |
Anti-CD20 antibody | 17,568 | 13,492 | 76.8% | 4076 | 23.2% | 2465 | 14.0% | 1087 | 6.2% | 449 | 2.6% | 75 | 0.4% |
HER2 inhibitor | 12,026 | 8099 | 67.3% | 3927 | 32.7% | 3000 | 24.9% | 440 | 3.7% | 389 | 3.2% | 98 | 0.8% |
EGFR inhibitor | 7177 | 2056 | 28.6% | 5121 | 71.4% | 4180 | 58.2% | 373 | 5.2% | 391 | 5.4% | 177 | 2.5% |
BCR-ABL inhibitor | 6387 | 5406 | 84.6% | 981 | 15.4% | 668 | 10.5% | 185 | 2.9% | 112 | 1.8% | 16 | 0.3% |
Proteasome inhibitors | 4031 | 2715 | 67.4% | 1316 | 32.6% | 757 | 18.8% | 358 | 8.9% | 177 | 4.4% | 24 | 0.6% |
Immune checkpoint inhibitor | 2699 | 1564 | 57.9% | 1135 | 42.1% | 918 | 34.0% | 153 | 5.7% | 47 | 1.7% | 17 | 0.6% |
Multikinase inhibitor | 2501 | 1246 | 49.8% | 1255 | 50.2% | 744 | 29.7% | 106 | 4.2% | 342 | 13.7% | 63 | 2.5% |
VEGFR inhibitor | 2067 | 1242 | 60.1% | 825 | 39.9% | 603 | 29.2% | 91 | 4.4% | 113 | 5.5% | 18 | 0.9% |
mTOR inhibitor | 1186 | 732 | 61.7% | 454 | 38.3% | 313 | 26.4% | 54 | 4.6% | 79 | 6.7% | 8 | 0.7% |
ALK inhibitor | 774 | 614 | 79.3% | 160 | 20.7% | 129 | 16.7% | 18 | 2.3% | 9 | 1.2% | 4 | 0.5% |
Retinoid | 561 | 300 | 53.5% | 261 | 46.5% | 114 | 20.3% | 116 | 20.7% | 26 | 4.6% | 5 | 0.9% |
JAK inhibitor | 457 | 408 | 89.3% | 49 | 10.7% | 35 | 7.7% | 13 | 2.8% | 1 | 0.2% | 0 | 0.0% |
Antibody–drug conjugate (ADC) | 380 | 244 | 64.2% | 136 | 35.8% | 94 | 24.7% | 26 | 6.8% | 9 | 2.4% | 7 | 1.8% |
CDK 4/6 inhibitor | 299 | 203 | 67.9% | 96 | 32.1% | 66 | 22.1% | 21 | 7.0% | 7 | 2.3% | 2 | 0.7% |
Anti-CCR4 antibody | 215 | 54 | 25.1% | 161 | 74.9% | 98 | 45.6% | 44 | 20.5% | 18 | 8.4% | 1 | 0.5% |
Anti-SLAMF7 antibody | 55 | 44 | 80.0% | 11 | 20.0% | 9 | 16.4% | 2 | 3.6% | 0 | 0.0% | 0 | 0.0% |
BTK inhibitor | 49 | 40 | 81.6% | 9 | 18.4% | 7 | 14.3% | 0 | 0.0% | 1 | 2.0% | 1 | 2.0% |
Anti-CD38 antibody | 15 | 13 | 86.7% | 2 | 13.3% | 2 | 13.3% | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% |
Histone deacetylase inhibitors | 11 | 5 | 45.5% | 6 | 54.5% | 3 | 27.3% | 3 | 27.3% | 0 | 0.0% | 0 | 0.0% |
Anti-CD52 antibody | 3 | 2 | 66.7% | 1 | 33.3% | 0 | 0.0% | 1 | 33.3% | 0 | 0.0% | 0 | 0.0% |
BRAF inhibitor | 1 | 1 | 100.0% | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% | 0 | 0.0% |
Bispecific CD19-directed CD3 T-cell engager antibody construct | 0 | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – |
FLT3-AXL inhibitor | 0 | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – |
MEK inhibitor | 0 | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – |
PARP inhibitor | 0 | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – |
Radioisotope-labeled antibody | 0 | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – | 0 | – |
Moisturizer Use
Number of Days Patients Were Treated with Anticancer Drugs (MTTs) during the Follow-Up Period
Total Number of Days for Which a Patient Used Moisturizers during the Follow-up Period, Total Amount (g) of Prescribed Moisturizers, and the Number and Proportion of Patients Who Were Prescribed Moisturizers by Month
n (%) | Quantity (g) | Period (days) | ||||
---|---|---|---|---|---|---|
Mean (SD) | Median (Q1–Q3) | Mean (SD) | Median (Q1–Q3) | |||
Heparinoids | 22,537 | 80.8% | 393.6 (692.8) | 150 (60–430) | 92.2 (79.4) | 56 (28–127) |
Petrolatum | 6615 | 23.7% | 127.8 (304.5) | 50 (20–100) | 48.5 (42.3) | 28 (28–56) |
Urea | 4356 | 15.6% | 174.4 (293.5) | 80 (40–200) | 70.3 (64.4) | 47 (28–84) |
Total Number of Days for Which a Patient Used Moisturizers after the Washout Period and the Total Amount (g) of Prescribed Moisturizers
Treatment with Radiotherapy during the Follow-up Period (Medical Remuneration Points and Management/Implementation Fee for Radiotherapy, Code: M001)
Total Medical Costs 6 Months and 12 Months from the Index Date, and the Costs of Outpatient Visits, Hospitalization, Drugs (MTTs, Other Drugs, and Moisturizers), and Radiotherapy
Group N | Group M | |||||||
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n | Mean (SD) | 95% CI | % of total medical costs | n | Mean (SD) | 95% CI | % of total medical costs | |
First 6 months of follow-up | ||||||||
Total medical costs | 50,284 | 28,788 (18,061) | 28,630–28,945 | 27,906 | 32,866 (20,222) | 32,629–33,104 | ||
Outpatient costs | 49,598 | 18,556 (15,097) | 18,423–18,689 | 64.5% | 27,246 | 18,220 (15,398) | 18,037–18,403 | 55.4% |
Inpatient costs | 32,117 | 16,415 (17,007) | 16,229–16,601 | 57.0% | 20,912 | 20,120 (20,889) | 19,837–20,403 | 61.2% |
Defined MTT costs | 50,284 | 16,541 (14,113) | 16,418–16,665 | 57.5% | 27,906 | 16,689 (14,536) | 16,518–16,859 | 50.8% |
Moisturizer costs | 0 | – | – | 20,656 | 35 (65) | 34–36 | 0.1% | |
Other drug costs | 49,564 | 5434 (6788) | 5374–5494 | 18.9% | 27,864 | 6500 (7709) | 6409–6590 | 19.8% |
Radiotherapy costs | 2893 | 2351 (1259) | 2305–2397 | 8.2% | 2176 | 2398 (1406) | 2339–2458 | 7.3% |
Entire 12 months of follow-up | ||||||||
Total medical costs | 50,284 | 44,814 (29,634) | 44,555–45,073 | 100.0% | 27,906 | 53,797 (32,183) | 53,419–54,174 | 100.0% |
Outpatient costs | 50,175 | 30,856 (26,524) | 30,624–31,088 | 68.9% | 27,774 | 31,358 (25,857) | 31,054–31,662 | 58.3% |
Inpatient costs | 34,939 | 20,185 (22,313) | 19,951–20,419 | 45.0% | 22,995 | 27,411 (29,834) | 27,026–27,797 | 51.0% |
Defined MTT costs | 50,284 | 25,838 (24,192) | 25,627–26,050 | 57.7% | 27,906 | 26,872 (23,761) | 26,593–27,151 | 50.0% |
Moisturizer costs | 0 | – | – | 27,906 | 53 (108) | 51–54 | 0.1% | |
Other drug costs | 49,808 | 8551 (11,271) | 8452–8650 | 19.1% | 27,898 | 10,880 (12,825) | 10,730–11,031 | 20.2% |
Radiotherapy costs | 4284 | 2478 (1321) | 2438–2517 | 5.5% | 3517 | 2525 (1449) | 2477–2573 | 4.7% |