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Costs associated with intravenous cancer therapy administration in patients with metastatic soft tissue sarcoma in a US population.

1. Introduction

Soft tissue sarcomas (STS) are a rare, complex group of childhood and adult neoplasms with differentiation towards mesenchymal tissue, which may arise almost anywhere in the body [1]. STS account for approximately 1% of malignant tumours in adults and 2% of total cancer mortality [2]. It is estimated that in 2012 approximately 10,280 people were diagnosed with STS in the United States (USA) [3]. STS exhibit remarkable histologic diversity and consist of a heterogeneous group of tumours with over 50 subtypes [2]. In a recent study of 17,364 cases of STS, malignant fibrous histiocytoma (24.1%), leiomyosarcoma (14.8%), sarcoma (12.8%), and myxoid liposarcoma (5.9%) were the most prevalent histological subtypes [4]. Although local control can be obtained through the use of surgery and radiotherapy, in patients who experience recurrence at distant sites (~50% of all patients), >90% will ultimately die of this malignancy [5]. The five-year survival rate for patients with advanced/metastatic disease is also low (e.g., 8% in patients with lung metastasis [6]).

The most commonly used chemotherapies in metastatic soft tissue sarcoma (mSTS) are intravenously (IV) administered agents [7]. Although the cost burden of IV cancer therapy (e.g., cost of IV administration and the cost of IV drugs) has been studied for specific cancer types (e.g., breast and small cell lung cancer) [8, 9] and other conditions, such as rheumatoid arthritis [10], no study to date has assessed the costs associated with IV cancer therapy administration in a mSTS population.

This study reports estimates of the total and component costs associated with IV cancer therapy administration in patients with mSTS from the payer perspective of the US health care system, based on an analysis of claims data from a large contract and claims management system.

2. Methods

2.1. Data Sources. Data for this study were obtained from the Experian Healthcare (Experian) database, which maintains a contract and claims management system that supports 350 general/oncology clinics in the US. The database contains a complete history of diagnoses (ICD-9-CM codes), procedures, and drug therapies received by both publicly and privately insured patients within the clinics, as well as patient demographics (e.g., age, gender, and geographic region) and insurance type (e.g., managed care, indemnity, Medicare, and Medicaid). For every patient clinic visit, Experian records the service dates, total charged, total contracted payments, and total allowed, with individual services, procedures, and drugs broken out by line item (Current Procedural Terminology, Fourth Edition [CPT-4] and Healthcare Common Procedure Coding System [HCPCS] codes). The Experian dataset used in this study covers the period from January 1, 2005, to April 30, 2012.

2.2. Study Design. This study employed a retrospective, longitudinal cohort design. The index date was defined as the date of the first IV cancer therapy infusion for mSTS treatment. Therapy windows were calculated as a patient-drug combination for the purposes of reporting study outcomes on a per month basis. The observation period for each patient-drug window begins at the index date and ends with either the last IV cancer therapy administration (if the patient only remains on one therapy) or the last visit of that IV cancer therapy before a patient switches to a different IV cancer therapy, plus a therapeutic effect. The therapeutic effect for patients that do not switch therapies is the average interval between administrations across the entire dataset for that particular IV cancer therapy. For patients who received a single IV therapy, the observation period length was calculated as the length of the therapy plus the average interval across the entire dataset for that particular IV cancer therapy. For patients that switch IV cancer therapies, the therapeutic effect is defined as the minimum of either the time between the last visit of that therapy and the start of the new therapy or average therapy interval across the entire dataset.

2.3. Study Population. The selection of patients in the study sample is depicted in Figure 1. The population of patients with mSTS receiving IV therapy was determined by a claims algorithm [11] that required patients to have (1) at least one diagnosis of a distant secondary malignant neoplasm (ICD-9CM 196.XX-199.0); (2) a diagnosis of mSTS between January 1, 2005, and April 30, 2012; and (3) at least one claim of an IV cancer therapy used to treat mSTS (defined according to NCCN treatment guidelines [7]) following mSTS diagnosis. (For the purposes of this study, IV cancer therapies used to treat mSTS included actinomycinD, bevacizumab, carboplatin, cisplatin, cyclophosphamide, dacarbazine, docetaxel, doxorubicin, epirubicin, etoposide, gemcitabine, ifosfamide, interferon, irinotecan, mesna, oxaliplatin, paclitaxel, temozolomide, topotecan, vincristine, and vinorelbine.) Diagnosis of mSTS was defined as at least two medical claims with an ICD-9-CM diagnosis code of 171, or the following combination of IV cancer therapies and other selected ICD-9-CM diagnoses:

(i) a combination therapy of ifosfamide (HCPCS: J9208, J9209, C9427) and doxorubicin or liposomal doxorubicin (HCPCS: J9000, J9001, C9415) (both agents to be administered within 30 days), except if also diagnosed with osteosarcoma (ICD-9-CM: 170), nasopharyngeal carcinoma (ICD-9-CM: 147), lung cancer (ICD-9CM:162.3-162.9), uterine cancer (ICD-9-CM: 179, 180, 182), breast cancer (ICD-9-CM:174), prostate cancer (ICD-9-CM: 185), renal cancer (ICD-9-CM: 189), or malignant neoplasm of lymphatic and hematopoietic tissue (ICD-9-CM: 200-208) at anytime, or

(ii) at least 1 medical claim for retroperitoneal or peritoneal cancer (ICD-9-CM: 158), except if also diagnosed with renal cell carcinoma (ICD-9-CM: 189.0, 198.0), transitional cell carcinoma (ICD-9-CM: 189.1, 189.2), mesothelioma (ICD-9-CM: 163), gastrointestinal stromal tumors (ICD-9-CM: 159.0, 159.8, 159.9), uterine cancer (ICD-9-CM: 179, 180, 182), ovarian cancer (ICD-9-CM: 183), or other and unspecified female genital-organ cancer (ICD-9-CM: 184) at any time.

2.4. Treatment Costs and IV Administration Related Costs. Treatment costs were estimated using the contracted allowed payment for a claim rather than the practice charges, based on adjudication of the claim by the patient's third-party insurance plan. A contracted payment is defined as the amount that the provider is eligible to receive from all parties, including primary and secondary payers and the patient, based on the contractual agreement with the payer. Because the contracted payment represents the actual payment to providers from payers, it depicts a more accurate and detailed view of the true economic burden to payers of IV cancer therapy administration in mSTS patients.

Treatment costs included all costs incurred on eligible IV cancer therapy dates of service. Costs were categorized as (i) IV cancer therapy administration procedure costs, (ii) IV cancer therapy drug costs for mSTS, and (iii) costs associated with other visit-related drugs and services provided on the day of the IV cancer therapy visit. Claim codes used to identify IV infusion administration costs are consistent with those used in previous research 8-10].

Treatment costs were calculated per patient per IV visit (PPPV) and per patient per month (pPpM). PPpM costs were calculated by first computing average per month treatment costs for each patient, defined as the sum of all costs on days with IV cancer therapy administrations during the observation period divided by the length of the observation period for each patient in person-months. Average PPPM treatment costs for the overall sample were then calculated as a weighted average of the average per month cost, using the length of the observation period as the weight. Reporting PPPM costs is an approach commonly used in nonexperimental study settings to account for different lengths of observation periods among study patients.

2.5. Statistical Analyses. Patient characteristics as of the index date were obtained from the Experian dataset. Age was standardized as patient age in 2009 and divided into five categories: less than 25, from 25 to 39, from 40 to 54, from 55 to 64, and greater than 64 years. Insurance type was defined at the time of the index mSTS diagnosis and was held constant during the study period. Patient characteristics were reported as frequencies and percentages for categorical variables and sample size, means, standard deviations, medians, and ranges for continuous variables.

Medians, means, standard deviations, and quartile ranges of PPPV and PPPM treatment costs were reported for the overall mSTS patient sample. The total and component IV administration costs were further stratified by patient cohorts based on age, gender, region, insurance status, IV drugs, and number of administered drugs during the visit. Cost data was adjusted based on the medical consumer price index (CPI) [12] and reported in 2011 in US dollars. Two sensitivity analyses were performed to assess potential biases arising from patient selection and outliers: (i) analyses were repeated based on an alternative definition of mSTS diagnosis in which patients were only required to have at least two medical claims with an ICD-9-CM diagnosis code of 171; (ii) analyses were repeated after excluding IV administration visits with administration costs in the top 1%. Analyses were performed using SAS 9.3 (SAS Institute, Inc., Cary, NC, USA).

3. Results

A total of 1,228 patients with mSTS were identified. Baseline patient characteristics are presented in Table 1. The sample included a broad range of the patient age groups with almost a quarter of patients with ages greater than 64 years. Gender was not consistently recorded on all claims; only about half (48%) of patients had gender recorded. The numbers of reported male and female patients in the sample were similar. About half (50.7%) of the patients were insured by managed care, and another quarter (25.0%) were covered by Medicare (either traditional FFS or Medicare HMOs). The South was the most represented region which contained about half (49.7%) of the patient sample, with fewer patients residing in the Northeast (3.3%) and Southwest (8.7%).

3.1. PPPV Costs. Per patient per IV visit costs (PPPV) in which an IV cancer therapy was administered, subdivided into IV drug costs, IV administration costs, and other visit-related service costs, are presented in Table 2. The mean (median) cost per IV visit across the entire mSTS patient sample was $2,427 ($1,532). IV administration costs represented 16.5% of these costs with a mean of $399 per visit. About three-quarters (74.5%) of the IV administration costs were associated with direct administration of the cancer therapy (infusion time), with the remaining quarter of costs associated with therapeutic, diagnostic, and prophylactic administration (24.1%) and hydration administration (1.4%).

Mean IV drug costs were $1,450 and represented 59.7% of the total cost of the visit. The remaining 23.8% of the visit costs ($578) were attributed to other visit-related services. Evaluation and management office visits, supplies and equipment, and other miscellaneous administration comprised a small part of these costs with a mean of $22 (3.7% of other visit-related services). The remaining 96.2% of other visit-related costs were other IV drugs and specially administered oral drugs. Drugs to treat the symptoms of the disease and side effects comprised the largest part of these other drugs: colony-stimulating factors mean cost of $160 per visit, antiemetic agents mean cost of $171 per visit, and antihypercalcemic agents mean cost of $30 per visit. The other large cost categories were off-label chemotherapy agents (mean cost of $50 PPPV) and monoclonal antibody agents (mean cost of $84 PPPV).

IV visit costs on a PPPV basis, broken down by age, gender, region, type of insurance, IV drug used to treat mSTS, and number of IV drugs administered per visit, are presented in Table 3(a). IV administration costs ranged from $311 to $457 (13.9% to 28.1% of total IV visit costs) across age groups. Patients with ages less than 25 years and greater than 64 years had the lowest administration costs. IV administration costs and costs of other visit-related services were very similar between females and males. Patients in the Southwest region reported the lowest IV administration costs ($308) and other visit-related services ($341), and patients in the West reported the highest IV administration costs ($489) and other visitrelated services ($646).

The largest differences in IV administration costs were found by insurance status. Managed care patients had the highest IV administration costs (mean $504 per visit) while Medicaid patients had the lowest (mean $92 per visit). The most expensive IV drugs in terms of IV administration costs were anthracycline-based therapies at $479 per visit and the cheapest were angiogenesis-based therapies at $301 per visit. Finally, costs of IV administration tended to increase with the number of IV drugs administered in a visit. Administering a single therapy cost an average of $304, increasing to $693 for three therapies and $936 for four therapies.

3.2. PPPM Costs. Total mean PPPM costs, subdivided into IV drug costs, IV administration costs, and other visit-related service costs, are presented in Table 2. Total mean (median) PPPM cost for the entire sample was $5,468 ($4,310) with quartile ranges from $2,066 to $7,431. Mean IV administration costs were $900 PPPM, of which $671 was due to chemotherapy administration, $217 was due to therapeutic, diagnostic, and prophylactic administration, and $12 was due to hydration administration. Mean PPPM cost per IV drug was $3,268 with quartile ranges between $427 and $4,704. Other visit-related costs were $1,300 PPPM. Supplies/equipment, evaluation and management office visits, and miscellaneous administration costs accounted for about $50 PPPM. Among other (i.e., non-mSTS) IV drugs administered during the visits, the costliest were those used to control side effects, including antiemetic agents ($384 PPPM) and colony-stimulating factors ($359 PPPM). Other high-cost categories include monoclonal antibody agents ($190 PPPM), off-label chemotherapy ($111 PPPM), and other miscellaneous agents ($113 PPPM).

IV visit costs on a PPPM basis, broken down by age, gender, region, type of insurance, IV drug used to treat mSTS, and number of IV drugs administered per visit, are presented in Table 3(b). Administration costs were similar across most age groups except for patients greater than 64 years, who had average administration costs about two-thirds ($623 PPPM) the size of the other age categories. Similar to the trend in total costs, patients in the Midwest and the West reported much higher IV administration costs PPPM at $1,080 and $1,030, respectively. Patients in the Northeast and Southwest reported much lower other visit-related costs than other regions.

Large variations in PPPM IV administration and other visit-related service costs were observed by insurance status. The highest IV administration PPPM costs were found in managed care patients and indemnity patients at $1,121 and $1,052, respectively. These patients also experienced higher other visit-related service costs compared to other insurance types. As with the PPPV results, other visit-related service costs were highest among patients with workers' compensation, Tricare, or self-pay insurance. In contrast to the PPPV where anthracycline-based agents were reported to have higher IV administration costs, the alkylating-based agents had much higher PPPM IV administration costs compared to the other therapies. Finally, the step-like trend of increasing IV administration costs based on the number of administered IV drugs during the visit was also observed in the PPPM analysis.

3.3. Sensitivity Analyses. Tables 4(a) and 4(b) report the results of two sensitivity analyses undertaken to assess the extent of any potential biases in the results arising from patient selection and outliers. In Table 4(a), total and subdivided PPPV costs were based on an alternative definition of mSTS diagnosis in which patients were only required to have at least two medical claims with an ICD-9-CM diagnosis code of 171. IV administration costs were generally similar and in fact represented a slightly larger percentage of total IV visit costs (17.1%), compared to those based on the primary definition of mSTS diagnosis presented in Table 3(a).

In Table 4(b), total and subdivided PPPV costs are reported after excluding visits with administration costs in the top 1%. Again, results were generally similar to those based on all IV administration visits, presented in Table 3(a). In particular, IV administration costs represented 15.9% of total IV visit costs.

4. Discussion

This retrospective analysis assessed costs associated with the administration of IV cancer therapies in mSTS patients from 2005 to 2012 using Experian data. IV administration costs accounted for about 16.5% of costs per IV visit among patients with mSTS. Other visit-related service costs accounted for about 23.8% of the cost PPPV. These results indicate that nonIV drug costs represent a considerable proportion of the total costs when receiving an IV cancer therapy to treat mSTS.

Cost estimates stratified by patient characteristics indicate that some of the largest differences in IV administration costs across patients exist between patients with different types of insurance. Patients with managed care had the highest IV administration costs ($504 PPPV), while Medicaid patients had the lowest ($92 PPPV). IV administration costs also varied widely across regions, as well as by the type of IV cancer drug and number of IV cancer drugs administered.

The share of total treatment costs related to IV administration reported in this study of mSTS patients is similar to estimates reported in both malignant and nonmalignant diseases where drugs are administered by IV infusion. A 2008 study of treatment costs in patients with metastatic breast cancer reported average total treatment costs of $2,477 PPPV, 10.2% of which were IV administration costs [9]. In a separate 2008 study of patients with small cell lung cancer, IV administration costs were estimated to be 11.8% of average total costs [8]. Finally, in a 2011 study of costs in rheumatoid arthritis patients, IV administration costs were 7.9% of average total costs [10].

This study did not account for indirect costs, such as those associated with patient and caregiver time (e.g., travel time) and lost productivity, which by their nature are more difficult to collect and suffer from greater variability. By only examining direct healthcare-system-related costs of IV cancer therapy administration in an mSTS sample, this study likely understates the true total cost of IV therapy to society.

As with all retrospective studies using claims data, identification of mSTS patients relies on the accuracy of diagnosis coding. No clinical information was available to ascertain stage. Advanced STS was identified based on a claims algorithm that has not been validated. To address this concern, a sensitivity analysis was performed where costs were calculated using an alternative claims algorithm. Results ofthis sensitivity analysis were similar to those reported here. In addition, costs related to IV cancer therapy administration were determined only from clinic claims and were limited to services identified on the claim as an infusion administration cost. This method may underestimate true medical infusion costs since it does not capture costs related to late infusion reactions and complications that require medical care on days following the infusion. Clinic claims also exclude any additional costs of oral drugs or drugs administered in an inpatient setting.

Other study limitations included limited information about patient enrollment and disease progression. Patients appear in the dataset through clinic visits, but the date of initial diagnosis of mSTS may have occurred earlier. In addition, it was not possible to determine why patients may have stopped visiting the clinic. It was also not possible to assess disease progression. To address these limitations, costs were estimated on the basis of actual clinic visits and reported both PPPV and PPPM.

5. Conclusion

Using data from the Experian database, this study found that the mean cost of receiving IV cancer therapy in an mSTS patient population was $2,427 PPPV and $5,468 PPPM. IV administration costs accounted for 16.5% of these costs and other visit-related services accounted for 23.8% of these costs. Thus, nonstudy drug related costs are about 40% of the costs associated with administration of IV cancer therapy for mSTS patients. There was substantial variation in the cost of IV administration by insurance type, region, type of anticancer drug, and the number of anticancer drugs administered in a single visit.

This study contributes to the understanding of IV therapy administration costs in mSTS patients. Further research is needed to investigate the association between IV administration costs and mSTS cancer stage and to estimate indirect costs of IV administration associated with mSTS patient and caregiver time.

http://dx.doi.org/10.1155/2013/947413

Acknowledgments

Research support was provided to Analysis Group, Inc., and Bruce Wong and Associates, Inc., by GlaxoSmithKline (GSK). Mei Sheng Duh, Jasmina I. Ivanova, Patrick Lefebvre, and Paul Karner are employees of Analysis Group, Inc. Bruce Wong is an employee of Bruce Wong and Associates, Inc. Gregory Kruse is a doctoral student at The Wharton School, University of Pennsylvania. Michelle D. Hackshaw and Lesley-Ann N. Miller are employees of and own stock in GSK. None of the authors have a direct financial interest in SAS Institute, Inc.

References

[1] Mayo Clinic, "Soft tissue sarcoma: definition," January 2012, http://www.mayoclinic.com/health/soft-tissue-sarcoma/DS00 601.

[2] C. Fletcher, K. Unni, and F. Mertens, Pathology and Genetics of Tumors of Soft Tissue and Bone, International Agency for Research on Cancer Press, Lyon, France, 2002.

[3] R. Siegel, D. Naishadham, and A. Jemal, "Cancer statistics, 2012," CA: Cancer Journal for Clinicians, vol. 62, no. 1, pp. 10-29, 2012.

[4] R. J. Canter, S. Beal, D. Borys, S. R. Martinez, R. J. Bold, and A. S. Robbins, "Interaction of histologic subtype and histologic grade in predicting survival for soft-tissue sarcomas," Journal of the American College of Surgeons, vol. 210, no. 2, pp. 191.e2198.e2, 2010.

[5] N. Penel, M. van Glabbeke, S. Marreaud, M. Ouali, J. Y. Blay, and P. Hohenberger, "Testing new regimens in patients with advanced soft tissue sarcoma: analysis of publications from the last 10 years," Annals of Oncology, vol. 22, no. 6, pp. 1266-1272, 2011.

[6] J.-Y. Blay, M. van Glabbeke, J. Verweij et al., "Advanced soft-tissue sarcoma: a disease that is potentially curable for a subset of patients treated with chemotherapy," European Journal of Cancer, vol. 39, no. 1, pp. 64-69, 2003.

[7] National Comprehensive Care Network, "NCCN clinical practice guidelines in onclogy: soft tissue sarcoma," June 2012, http://www.nccn.org/professionals/physiciamgls/pdf/sarcoma .pdf.

[8] M. S. Duh, J. R. Weiner, P. Lefebvre, M. Neary, and A. T. Skarin, "Costs associated with intravenous chemotherapy administration in patients with small cell lung cancer: a retrospective claims database analysis," Current Medical Research and Opinion, vol. 24, no. 4, pp. 967-974, 2008.

[9] G. B. Kruse, M. M. Amonkar, G. Smith, D. C. Skonieczny, and S. Stavrakas, "Analysis of costs associated with administration of intravenous single-drug therapies in metastatic breast cancer in a U.S. population," Journal of Managed Care Pharmacy, vol. 14, no. 9, pp. 844-857, 2008.

[10] B. J. Wong, M. A. Cifaldi, S. Roy, D. C. Skonieczny, and S. Stavrakas, "Analysis of drug and administrative costs allowed by U.S. Private and public third-party payers for 3 intravenous biologic agents for rheumatoid arthritis," Journal of Managed Care Pharmacy, vol. 17, no. 4, pp. 313-320, 2011.

[11] J. E. Butrynski, M. S. Duh, A. A. Fournier et al., "Soft tissue sarcoma (STS): challenges identification, treatment patterns, and cost of disease management in the U.S.," Journal of Clinical Oncology, vol. 26, no. 15, ASCO Annual Meeting Proceedings, Chicago, Ill, USA, Abstract 10573, 2008.

[12] Bureau of Labor Statistics, "U.S. medical care services," http:// data.bls.gov.

Mei Sheng Duh, (1) Michelle D. Hackshaw, (2) Jasmina I. Ivanova, (1) Gregory Kruse, (3) Lesley-Ann N. Miller, (2) Patrick Lefebvre, (1) Paul Karner, (1) Bruce Wong (4)

(1) Analysis Group, Inc., Ill Huntington Avenue, Tenth Floor, Boston, MA 02199, USA

(2) GlaxoSmithKline, Philadelphia, PA 19102, USA

(3) University of Pennsylvania, Philadelphia, PA 19104, USA

(4) Bruce Wong and Associates, Inc., Wayne, PA 19087, USA

Correspondence should be addressed to Mei Sheng Duh; mduh@analysisgroup.com

Received 12 June 2013; Accepted 25 November 2013

Academic Editor: Luca Sangiorgi

Table 1: Patient characteristics for mSTS sample.

Patient              Count         Percent
characteristic       (N = 1,228)

Age (1)
  Less than 25       117            9.5%
  25 to 39           152           12.4%
  40 to 54           316           25.7%
  55 to 64           345           28.1%
  Greater than 64    298           24.3%
Gender (2)
  Female             289           23.5%
  Male               295           24.0%
Insurance type (3)
  Managed care       622           50.7%
  Medicare           283           23.0%
  Medicare HMO        24            2.0%
  Medicaid            67            5.5%
  Medicaid HMO        10            0.8%
  Indemnity           68            5.5%
  Other (4)          154           12.5%
Region
  Midwest            240           19.5%
  Northeast           41            3.3%
  South              610           49.7%
  Southwest          107            8.7%
  West               230           18.7%

1: Age of the patient in 2009.

2: 644 patients were missing gender information.

3: Insurance type is defined at the time of the index mSTS
diagnosis.

4: Other includes workers' compensation, Tricare, and self-pay.

Table 2: IV visit costs per patient per visit (PPPV) and per
patient per month (PPPM) by cost categories.

No. of visits               13,583
PPPV                        6,025
PPPM
Cost category               Sum ($) (2)   %        Median

Total                       32,970,401    100.0%   1,532.11
IV administration           5,425,305     16.5%    342.01
  Chemotherapy              4,044,094     74.5%    253.53
  administration
  Hydration                 75,244        1.4%     0.00
  administration
  Therapeutic,              1,305,967     24.1%    77.40
  diagnostic,
  prophylactic admin.
IV drug (for mSTS)          19,693,317    59.7%    537.77
Other visit-related         7,851,778     23.8%    190.55
  services
  Miscellaneous             112,606       1.4%     0.00
  administration
  Supplies/ equipment       14,537        0.2%     0.00
  Office visit/evaluation   168,391       2.1%     0.00
  and mgmt. services
  Other IV drugs/           7,556,244     96.2%    185.76
  specially
  admin, oral drugs
Antihypercalcemic agents    407,395       5.4%     0.00
Colony-stimulating factor   2,175,927     28.8%    0.00
Antiemetic                  2,317,729     30.7%    95.85
Use for IV infusion         90,036        1.2%     0.00
Corticosteroid for          53,693        0.7%     1.09
  hypersensitivity
Used to clear (flush) IV    6,515         0.1%     0.00
  lines or catheters
H2 antagonists for          3,533         0.0%     0.00
  hypersensitivity
For anemia                  4,987         0.1%     0.00
Anticancer agent            1,143,295     15.1%    0.00
  monoclonal antibody
Anticancer agent            674,420       8.9%     0.00
  chemotherapy
Mise, other drugs           678,714       9.0%     0.00

No. of visits               Costs PPPV ($) (1)
PPPV
PPPM
Cost category               Mean       Std.       1st
                                       dev.       quartile

Total                       2,427.33   2,674.95   720.50
IV administration             399.42     291.78   226.62
  Chemotherapy                297.73     227.91   163.67
  administration
  Hydration                     5.54      23.55     0.00
  administration
  Therapeutic,                 96.15     100.63    31.94
  diagnostic,
  prophylactic admin.
IV drug (for mSTS)          1,449.85   2,175.31    98.59
Other visit-related           578.06   1,178.00    42.31
  services
  Miscellaneous                 8.29      72.83     0.00
  administration
  Supplies/ equipment           1.07      13.76     0.00
  Office visit/evaluation      12.40      41.77     0.00
  and mgmt. services
  Other IV drugs/             556.30   1,167.77    17.25
  specially
  admin, oral drugs
Antihypercalcemic agents       29.99     260.40     0.00
Colony-stimulating factor     160.19     699.58     0.00
Antiemetic                    170.63     220.46     0.71
Use for IV infusion             6.63      15.56     0.00
Corticosteroid for              3.95      16.74     0.00
  hypersensitivity
Used to clear (flush) IV        0.48       5.49     0.00
  lines or catheters
H2 antagonists for              0.26       2.54     0.00
  hypersensitivity
For anemia                      0.37       7.79     0.00
Anticancer agent               84.17     713.08     0.00
  monoclonal antibody
Anticancer agent               49.65     319.96     0.00
  chemotherapy
Mise, other drugs              49.97     358.51     0.00

No. of visits               Costs PPPV ($) (1)
PPPV
PPPM
Cost category               3rd        Median
                            quartile

Total                       3,187.80   4,310.20
IV administration             513.84     678.54
  Chemotherapy                379.00     489.72
  administration
  Hydration                     0.00       0.00
  administration
  Therapeutic,                130.82     156.15
  diagnostic,
  prophylactic admin.
IV drug (for mSTS)          1,828.55   2,236.07
Other visit-related           483.00     725.44
  services
  Miscellaneous                 0.00       0.00
  administration
  Supplies/ equipment           0.00       0.00
  Office visit/evaluation       0.00       0.00
  and mgmt. services
  Other IV drugs/             468.02     688.65
  specially
  admin, oral drugs
Antihypercalcemic agents        0.00       0.00
Colony-stimulating factor       0.00       0.00
Antiemetic                    254.66     291.67
Use for IV infusion             2.72       0.21
Corticosteroid for              2.33       2.67
  hypersensitivity
Used to clear (flush) IV        0.00       0.00
  lines or catheters
H2 antagonists for              0.00       0.00
  hypersensitivity
For anemia                      0.00       0.00
Anticancer agent                0.00       0.00
  monoclonal antibody
Anticancer agent                0.00       0.00
  chemotherapy
Mise, other drugs               1.34       1.93

No. of visits               Costs PPPM ($) (1)
PPPV
PPPM
Cost category               Mean       Std. dev.   1st        3rd
                                                   quartile   quartile

Total                       5,467.61   133.01      2,065.64   7,430.99
IV administration             899.57    24.91        395.94   1,130.75
  Chemotherapy                670.50    19.34        282.65     832.90
  administration
  Hydration                    12.45     1.26          0.00       2.55
  administration
  Therapeutic,                216.61     7.12         72.72     276.57
  diagnostic,
  prophylactic admin.
IV drug (for mSTS)          3,268.45   102.50        427.21   4,703.56
Other visit-related         1,299.60    51.60        294.02   1,573.49
  services
  Miscellaneous                18.68     1.52          0.00      15.69
  administration
  Supplies/ equipment           2.39     0.57          0.00       0.00
  Office visit/evaluation      27.90     2.00          0.00       4.18
  and mgmt. services
  Other IV drugs/           1,250.63    51.33        241.48   1,498.94
  specially
  admin, oral drugs
Antihypercalcemic agents       67.62     7.25          0.00       0.00
Colony-stimulating factor     358.66    27.14          0.00      58.14
Antiemetic                    384.22    11.32         54.81     556.62
Use for IV infusion            14.94     1.25          0.00       5.39
Corticosteroid for              8.91     0.91          0.98       6.32
  hypersensitivity
Used to clear (flush) IV        1.08     0.39          0.00       0.00
  lines or catheters
H2 antagonists for              0.59     0.08          0.00       0.00
  hypersensitivity
For anemia                      0.83     0.23          0.00       0.00
Anticancer agent              189.76    32.30          0.00       0.00
  monoclonal antibody
Anticancer agent              111.43    21.30          0.00       0.00
  chemotherapy
Mise, other drugs             112.59    10.55          0.00      26.98

1: Treatment costs derived from the contracted
allowed payment for a claim.

2: Sum over all visits/months and patients.

Table 3: (a) Cost categories breakdown per patient per visit (PPPV)
by demographic characteristics, IV drug, and number of drugs
administered per visit (1), (b) Cost categories breakdown per
patient per month (PPPM) by demographic characteristics, IV drug,
and number of drugs administered per visit (1).

(a)
Category                     No. of     No. of    Total
                            patients   visits    Average       %
                                                 costs ($)

Total                       1,228      13,583    2,427.33    100.0%
Age
  Less than 25                117       1,944     1,117.32   100.0%
  25 to 39                    152       2,001     2,228.42   100.0%
  40 to 54                    316       3,471     2,632.44   100.0%
  55 to 64                    345       3,351     3,292.29   100.0%
  Greater than 64             298       2,816     2,190.91   100.0%
Gender
  Female                      289       3,367     2,149.91   100.0%
  Male                        295       3,617     2,082.48   100.0%
  Region
  Midwest                     240       2,653     2,471.90   100.0%
  Northeast                    41         342     2,240.14   100.0%
  South                       610       7,112     2,140.51   100.0%
  Southwest                   107       1,064     1,675.80   100.0%
  West                        230       2,412     3,582.08   100.0%
Insurance type (3)
  Managed care                622       6,874     2,936.17   100.0%
  Medicare                    283       2,763     1,879.52   100.0%
  Medicare HMO                 24         251     1,543.22   100.0%
  Medicaid                     67         787       859.31   100.0%
  Medicaid HMO                 10         145       709.35   100.0%
  Indemnity                    68       1,036     2,199.25   100.0%
  Other (4)                   154       1,727     2,402.50   100.0%
IV drug (for mSTS) (5)
  Gemcitabine-b ased          429       3,315     3,302.95   100.0%
  Anthracycline-based         434       2,005     2,344.63   100.0%
  Alkylating-agents-based     424       3,772     1,469.59   100.0%
  Angiogenesis inhibitors      58         374     5,249.94   100.0%
  Taxane-based                172       1,123     2,184.18   100.0%
  Other                       352       2,994     2,458.42   100.0%
Number of
  administered IV
  drugs (6)
  One                         998       8,016     1,855.27   100.0%
  Two                         680       4,336     3,423.98   100.0%
  Three                       161       1,049     2,515.14   100.0%
  Four                         47         182     3,372.39   100.0%
Total                       1,228     6,025.0     5,467.61   100.0%
Age
  Less than 25                117       623.3     3,476.65   100.0%
  25 to 39                    152       836.2     5,338.35   100.0%
  40 to 54                    316     1,513.3     6,030.91   100.0%
  55 to 64                    345     1,650.8     6,686.45   100.0%
  Greater than 64             298     1,401.4     4,386.23   100.0%
Gender (2)
  Female                      289     1,588.8     4,544.31   100.0%
  Male                        295     1,563.7     4,819.57   100.0%
Region
  Midwest                     240     1,040.6     6,289.83   100.0%
  Northeast                    41       207.8     3,687.44   100.0%
  South                       610     3,200.9     4,753.24   100.0%
  Southwest                   107       434.6     4,106.94   100.0%
  West                        230     1,141.2     7,563.95   100.0%
Insurance type (3)
  Managed care                622     3,088.9     6,532.36   100.0%
  Medicare                    283     1,374.0     3,764.41   100.0%
  Medicare HMO                 24       113.4     3,415.78   100.0%
  Medicaid                     67       375.7     1,804.71   100.0%
  Medicaid HMO                 10        37.9     2,716.27   100.0%
  Indemnity                    68       365.1     6,232.59   100.0%
  Other (4)                   154       670.0     6,191.80   100.0%
IV drug (for mSTS)
  Gemcitabine-based           429     1,577.9     7,021.77   100.0%
  Anthracycline-based         434     1,243.0     3,752.46   100.0%
  Alkylating-agents-based     424     1,221.5     4,753.73   100.0%
  Angiogenesis inhibitors      58       321.6     7,532.36   100.0%
  Taxane-based                172       575.0     4,253.79   100.0%
  Other (5)                   352     1,086.0     6,006.84   100.0%
Number of
  administered IV
  drugs (6)
  One                         998     2,492.2     3,950.35   100.0%
  Two                         680     2,781.1     6,616.14   100.0%
  Three                       161       514.1     6,725.12   100.0%
  Four                         47       237.6     5,218.13   100.0%

Category                         IV drug         IV administration

                            Average      %       Average      %
                            costs ($)            costs ($)

Total                       1,449.85    59.7%     399.42    16.5%
Age
  Less than 25                462.60    41.4%     314.53    28.1%
  25 to 39                  1,276.28    57.3%     447.07    20.1%
  40 to 54                  1,531.81    58.2%     435.10    16.5%
  55 to 64                  2,057.09    62.5%     457.14    13.9%
  Greater than 64           1,431.09    65.3%     311.49    14.2%
Gender (2)
  Female                    1,282.05    59.6%     341.70    15.9%
  Male                      1,162.35    55.8%     360.57    17.3%
Region
  Midwest                   1,485.45    60.1%     424.76    17.2%
  Northeast                 1,348.44    60.2%     391.31    17.5%
  South                     1,166.50    54.5%     373.68    17.5%
  Southwest                 1,026.85    61.3%     308.40    18.4%
  West                      2,447.14    68.3%     488.75    13.6%
Insurance type (3)
  Managed care              1,783.86    60.8%     504.22    17.2%
  Medicare                  1,182.80    62.9%     271.84    14.5%
  Medicare HMO                880.70    57.1%     241.51    15.6%
  Medicaid                    344.74    40.1%      91.61    10.7%
  Medicaid HMO                334.71    47.2%     185.94    26.2%
  Indemnity                 1,359.22    61.8%     371.24    16.9%
  Other (4)                 1,281.98    53.4%     384.41    16.0%
IV drug (for mSTS) (5)
  Gemcitabine-b ased        2,447.16    74.1%     358.70    10.9%
  Anthracycline-based       1,024.02    43.7%     479.23    20.4%
  Alkylating-agents-based     474.53    32.3%     433.81    29.5%
  Angiogenesis inhibitors   4,291.45    81.7%     301.03     5.7%
  Taxane-based              1,323.34    60.6%     409.22    18.7%
  Other                     1,552.03    63.1%     356.33    14.5%
Number of
  administered IV
  drugs (6)
  One                       1,007.91    54.3%     304.23    16.4%
  Two                       2,348.01    68.6%     481.76    14.1%
  Three                     1,058.61    42.1%     693.36    27.6%
  Four                      1,771.78    52.5%     935.96    27.8%
Total                       3,268.45    59.8%     899.57    16.5%
Age
  Less than 25              1,442.50    41.5%     978.12    28.1%
  25 to 39                  3,054.94    57.2%   1,070.62    20.1%
  40 to 54                  3,511.16    58.2%     997.38    16.5%
  55 to 64                  4,181.94    62.5%     928.28    13.9%
  Greater than 64           2,869.85    65.4%     623.09    14.2%
Gender (2)
  Female                    2,712.88    59.7%     721.32    15.9%
  Male                      2,689.15    55.8%     835.49    17.3%
Region
  Midwest                   3,784.40    60.2%   1,079.88    17.2%
  Northeast                 2,219.64    60.2%     644.12    17.5%
  South                     2,590.95    54.5%     830.59    17.5%
  Southwest                 2,531.00    61.6%     754.76    18.4%
  West                      5,170.11    68.4%   1,030.27    13.6%
Insurance type (3)
  Managed care              3,971.37    60.8%   1,120.58    17.2%
  Medicare                  2,374.73    63.1%     544.94    14.5%
  Medicare HMO              1,949.36    57.1%     534.56    15.6%
  Medicaid                    722.61    40.0%     196.05    10.9%
  Medicaid HMO              1,281.66    47.2%     712.02    26.2%
  Indemnity                 3,853.04    61.8%   1,051.79    16.9%
  Other (4)                 3,305.31    53.4%     991.86    16.0%
IV drug (for mSTS)
  Gemcitabine-based         5,208.74    74.2%     761.17    10.8%
  Anthracycline-based       1,629.15    43.4%     768.24    20.5%
  Alkylating-agents-based   1,559.65    32.8%   1,365.87    28.7%
  Angiogenesis inhibitors   6,191.35    82.2%     460.33     6.1%
  Taxane-based              2,563.94    60.3%     802.76    18.9%
  Other (5)                 3,755.13    62.5%     907.76    15.1%
  Number of
  administered IV
  drugs (6)
  One                       2,105.69    53.3%     610.28    15.4%
  Two                       4,463.78    67.5%     954.84    14.4%
  Three                     2,888.23    42.9%   1,631.79    24.3%
  Four                      2,296.07    44.0%   1,702.72    32.6%

Category                    Other visit-related services

                                 Average       %
                                 costs ($)

Total                             578.06    23.8%
Age
  Less than 25                    340.19    30.4%
  25 to 39                        505.07    22.7%
  40 to 54                        665.52    25.3%
  55 to 64                        778.06    23.6%
  Greater than 64                 448.33    20.5%
Gender (2)
  Female                          526.16    24.5%
  Male                            559.56    26.9%
Region
  Midwest                         561.69    22.7%
  Northeast                       500.39    22.3%
  South                           600.33    28.0%
  Southwest                       340.56    20.3%
  West                            646.19    18.0%
Insurance type (3)
  Managed care                    648.10    22.1%
  Medicare                        424.88    22.6%
  Medicare HMO                    421.01    27.3%
  Medicaid                        422.96    49.2%
  Medicaid HMO                    188.70    26.6%
  Indemnity                       468.80    21.3%
  Other (4)                       736.11    30.6%
IV drug (for mSTS) (5)
  Gemcitabine-b ased              497.09    15.0%
  Anthracycline-based             841.38    35.9%
  Alkylating-agents-based         561.25    38.2%
  Angiogenesis inhibitors         657.47    12.5%
  Taxane-based                    451.62    20.7%
  Other                           550.06    22.4%
  Number of
  administered IV
  drugs (6)
  One                             543.13    29.3%
  Two                             594.21    17.4%
  Three                           763.17    30.3%
  Four                            664.65    19.7%
Total                           1,299.60    23.8%
Age
  Less than 25                  1,056.03    30.4%
  25 to 39                      1,212.80    22.7%
  40 to 54                      1,522.37    25.2%
  55 to 64                      1,576.23    23.6%
  Greater than 64                 893.29    20.4%
Gender (2)
  Female                        1,110.11    24.4%
  Male                          1,294.93    26.9%
Region
  Midwest                       1,425.55    22.7%
  Northeast                       823.67    22.3%
  South                         1,331.70    28.0%
  Southwest                       821.18    20.0%
  West                          1,363.58    18.0%
Insurance type (3)
  Managed care                  1,440.41    22.1%
  Medicare                        844.73    22.4%
  Medicare HMO                    931.86    27.3%
  Medicaid                        886.05    49.1%
  Medicaid HMO                    722.59    26.6%
  Indemnity                     1,327.76    21.3%
  Other (4)                     1,894.63    30.6%
IV drug (for mSTS)
  Gemcitabine-based             1,051.86    15.0%
  Anthracycline-based           1,355.07    36.1%
  Alkylating-agents-based       1,828.21    38.5%
  Angiogenesis inhibitors         880.67    11.7%
  Taxane-based                    887.08    20.9%
  Other (5)                     1,343.95    22.4%
Number of
  administered IV
  drugs (6)
  One                           1,234.38    31.2%
  Two                           1,197.52    18.1%
  Three                         2,205.10    32.8%
  Four                          1,219.34    23.4%

1: Treatment costs derived from the contracted
allowed payment for a claim.

2: 644 patients were missing gender information.

0.125 Insurance type is defined at the time of the index mSTS
diagnosis.

4: Other includes workers' compensation, Tricare, and self-pay.

5: Gemcitabine-based includes gemcitabine monotherapy
and combination therapies. Anthracycline-based includes doxorubicin
and epirubicin monotherapies and combination therapies.
Alkylating-agents-based includes monotherapies and combination
therapies with cisplatin, cyclophosphamide, dacarbazine, etoposide,
ifosfamide, temozolomide, and topotecan. Angiogenesis inhibitors
include bevacizumab monotherapy. Taxane-based includes docetaxel and
paclitaxel monotherapies and combination therapies. Other includes
actinomycin D, carboplatin, irinotecan, interferon, oxaliplatin,
vincristine, and vinorelbine.

6: Number of mSTS treatments that were administered during the visit.

Table 4: (a) Cost categories breakdown per patient per visit (PPPV)
by demographic characteristics, IV drug, and number of drugs
administered per visit: sensitivity analyses using alternative
definition of mSTS diagnosis1, (b) Cost categories breakdown per
patient per visit (PPPV) by demographic characteristics, IV drug, and
number of drugs administered per visit: sensitivity analyses
excluding visits with administration costs in the top 1% (1).

(a)
Category                     No. of     No. of   Total       %

                          patients   visits   Average
                                              costs ($)

Total                       1,023      11,777   2,293.60    100.0%
Age
  Less than 25                112       1,872   1,067.78    100.0%
  25 to 39                    138       1,897   2,077.10    100.0%
  40 to 54                    266       2,999   2,569.69    100.0%
  55 to 64                    282       2,833   3,159.29    100.0%
  Greater than 64             225       2,176   2,029.35    100.0%
Gender (2)
  Female                      234       2,882   1,971.97    100.0%
  Male                        234       3,156   1,856.48    100.0%
Region
  Midwest                     189       2,235   2,206.58    100.0%
  Northeast                    19         199   2,733.61    100.0%
  South                       513       6,204   2,001.71    100.0%
  Southwest                    95         985   1,620.03    100.0%
  West                        207       2,154   3,491.98    100.0%
Insurance type (3)
  Managed care                530       6,076   2,773.41    100.0%
  Medicare                    217       2,200   1,756.68    100.0%
  Medicare HMO                 19         181   1,808.04    100.0%
  Medicaid                     61         756     814.99    100.0%
  Medicaid HMO                  9         141     614.82    100.0%
  Indemnity                    55         881   2,003.24    100.0%
  Other (4)                   132       1,542   2,270.35    100.0%
IV drug (for mSTS) (5)
  Gemcitabine-b ased          374       2,926   3,438.08    100.0%
  Anthracycline-based         406       1,904   2,304.97    100.0%
  Alkylating-agents-based     383       3,416   1,494.70    100.0%
  Angiogenesis inhibitors      33         250   5,499.09    100.0%
  Taxane-based                141         945   2,280.97    100.0%
  Other                       260       2,336   1,681.11    100.0%
Number of administered
  IV drugs (6)
  One                         831       6,874   1,717.75    100.0%
  Two                         581       3,779   3,245.44    100.0%
  Three                       148         963   2,449.85    100.0%
  Four                         44         161   3,603.77    100.0%

Category                         IV drug         IV administration

                            Average             Average
                            costs ($)     %     costs ($)     %

Total                       1,334.09    58.2%   392.81      17.1%
Age
  Less than 25                435.96    40.8%   304.44      28.5%
  25 to 39                  1,153.72    55.5%   439.82      21.2%
  40 to 54                  1,486.01    57.8%   442.27      17.2%
  55 to 64                  1,941.58    61.5%   438.70      13.9%
  Greater than 64           1,263.70    62.3%   299.93      14.8%
Gender (2)
  Female                    1,135.12    57.6%   332.27      16.8%
  Male                        970.27    52.3%   347.30      18.7%
Region
  Midwest                   1,292.76    58.6%   423.45      19.2%
  Northeast                 1,665.07    60.9%   367.43      13.4%
  South                     1,021.93    51.1%   367.81      18.4%
  Southwest                 1,021.50    63.1%   308.51      19.0%
  West                      2,388.44    68.4%   473.90      13.6%
Insurance type (3)
  Managed care              1,646.46    59.4%   492.05      17.7%
  Medicare                  1,073.70    61.1%   271.13      15.4%
  Medicare HMO                959.11    53.0%   274.88      15.2%
  Medicaid                    282.49    34.7%    93.08      11.4%
  Medicaid HMO                233.36    38.0%   187.46      30.5%
  Indemnity                 1,200.97    60.0%   373.60      18.6%
  Other (4)                 1,211.04    53.3%   365.92      16.1%
IV drug (for mSTS) (5)
  Gemcitabine-b ased        2,551.62    74.2%   366.02      10.6%
  Anthracycline-based       1,006.55    43.7%   483.34      21.0%
  Alkylating-agents-based     498.44    33.3%   430.76      28.8%
  Angiogenesis inhibitors   4,413.94    80.3%   276.56       5.0%
  Taxane-based              1,371.47    60.1%   416.92      18.3%
  Other                       953.29    56.7%   299.76      17.8%
Number of administered
  IV drugs (6)
  One                         890.29    51.8%   295.14      17.2%
  Two                       2,178.48    67.1%   467.91      14.4%
  Three                     1,097.77    44.8%   696.15      28.4%
  Four                      1,876.43    52.1%   985.49      27.3%

Category                  Other visit-relate services

                            Average
                            costs ($)     %

Total                       566.71      24.7%
Age
  Less than 25              327.38      30.7%
  25 to 39                  483.56      23.3%
  40 to 54                  641.41      25.0%
  55 to 64                  779.01      24.7%
  Greater than 64           465.72      22.9%
Gender (2)
  Female                    504.58      25.6%
  Male                      538.91      29.0%
Region
  Midwest                   490.38      22.2%
  Northeast                 701.11      25.6%
  South                     611.97      30.6%
  Southwest                 290.02      17.9%
  West                      629.64      18.0%
Insurance type (3)
  Managed care              634.91      22.9%
  Medicare                  411.86      23.4%
  Medicare HMO              574.05      31.7%
  Medicaid                  439.42      53.9%
  Medicaid HMO              193.99      31.6%
  Indemnity                 428.67      21.4%
  Other (4)                 693.39      30.5%
IV drug (for mSTS) (5)
  Gemcitabine-b ased        520.44      15.1%
  Anthracycline-based       815.08      35.4%
  Alkylating-agents-based   565.51      37.8%
  Angiogenesis inhibitors   808.59      14.7%
  Taxane-based              492.59      21.6%
  Other                     428.06      25.5%
Number of administered
  IV drugs (6)
  One                       532.32      31.0%
  Two                       599.05      18.5%
  Three                     655.92      26.8%
  Four                      741.85      20.6%

(1): mSTS diagnosis defined as at least two medical
claims with an ICD-9-CM diagnosis code of 171 and at least one
medical claims with a diagnosis of a distant secondary malignant
neoplasm (ICD-9-CM 196.XX- 199.0). Treatment costs derived from the
contracted allowed payment for a claim.

(2): 644 patients were missing gender information.

(3): Insurance type is defined at the time of the index mSTS
diagnosis.

(4): Other includes workers' compensation, Tricare, and self-pay.

(5): Gemcitabine-based includes gemcitabine monotherapy
and combination therapies. Anthracycline-based includes doxorubicin
and epirubicin monotherapies and combination therapies.
Alkylating-agents-based includes monotherapies and combination
therapies with cisplatin, cyclophosphamide, dacarbazine, etoposide,
ifosfamide, temozolomide, and topotecan. Angiogenesis inhibitors
include bevacizumab monotherapy. Taxane-based includes docetaxel and
paclitaxel monotherapies and combination therapies. Other includes
actinomycin D, carboplatin, irinotecan, interferon, oxaliplatin,
vincristine, and vinorelbine.

(6): Number of mSTS treatments that were administered during the visit.

(b)

Category                    No. of     No. of    Total        %
                           patients    visits   Average
                                                costs ($)

Total                       1,221      13,325   2,363.53    100.0%
Age
  Less than 25                116       1,934   1,104.42    100.0%
  25 to 39                    151       1,953   2,170.22    100.0%
  40 to 54                    313       3,377   2,565.44    100.0%
  55 to 64                    344       3,274   3,227.77    100.0%
  Greater than 64             297       2,787   2,112.86    100.0%
Gender (2)
  Female                      289       3,352   2,143.16    100.0%
  Male                        295       3,604   2,073.06    100.0%
Region
  Midwest                     240       2,636   2,454.05    100.0%
  Northeast                    41         339   2,242.53    100.0%
  South                       604       6,969   2,084.97    100.0%
  Southwest                   107       1,062   1,669.85    100.0%
  West                        229       2,319   3,433.15    100.0%
Insurance type (3)
  Managed care                615       6,647   2,838.48    100.0%
  Medicare                    283       2,759   1,875.14    100.0%
  Medicare HMO                 24         251   1,543.22    100.0%
  Medicaid                     67         787     859.31    100.0%
  Medicaid HMO                 10         145     709.35    100.0%
  Indemnity                    68       1,036   2,199.25    100.0%
  Other (4)                   154       1,700   2,357.83    100.0%
IV drug (for mSTS) (5)
  Gemcitabine-b ased          429       3,305   3,290.15    100.0%
  Anthracycline-based         423       1,925   2,275.39    100.0%
  Alkylating-agents-based     419       3,686   1,396.09    100.0%
  Angiogenesis inhibitors      58         367   5,217.74    100.0%
  Taxane-based                172       1,106   2,141.45    100.0%
  Other                       348       2,936   2,319.72    100.0%
Number of administere
  IV drugs (6)
  One                         997       7,994   1,842.21    100.0%
  Two                         670       4,229   3,333.67    100.0%
  Three                       156         966   2,353.14    100.0%
  Four                         39         136   2,913.93    100.0%

Category                        IV drug        IV administration

                            Average     %       Average     %
                           costs ($)           costs ($)

Total                      1,417.87    60.0%   376.94      15.9%
Age
  Less than 25               459.15    41.6%   307.88      27.9%
  25 to 39                 1,251.49    57.7%   423.35      19.5%
  40 to 54                 1,521.19    59.3%   402.53      15.7%
  55 to 64                 2,021.82    62.6%   429.45      13.3%
  Greater than 64          1,365.08    64.6%   299.66      14.2%
Gender (2)
  Female                   1,278.43    59.7%   337.16      15.7%
  Male                     1,158.90    55.9%   357.01      17.2%
Region
  Midwest                  1,478.01    60.2%   417.56      17.0%
  Northeast                1,357.27    60.5%   383.64      17.1%
  South                    1,150.36    55.2%   347.76      16.7%
  Southwest                1,023.82    61.3%   306.28      18.3%
  West                     2,342.75    68.2%   449.85      13.1%
Insurance type (3)
  Managed care             1,737.24    61.2%   468.51      16.5%
  Medicare                 1,180.06    62.9%   270.15      14.4%
  Medicare HMO               880.70    57.1%   241.51      15.6%
  Medicaid                   344.74    40.1%    91.61      10.7%
  Medicaid HMO               334.71    47.2%   185.94      26.2%
  Indemnity                1,359.22    61.8%   371.24      16.9%
  Other (4)                1,259.37    53.4%   364.05      15.4%
IV drug (for mSTS) (5)
  Gemcitabine-b ased       2,439.82    74.2%   354.74      10.8%
  Anthracycline-based      1,022.92    45.0%   432.97      19.0%
  Alkylating-agents-based    441.77    31.6%   405.93      29.1%
  Angiogenesis inhibitors  4,275.64    81.9%   281.20       5.4%
  Taxane-based             1,300.21    60.7%   392.87      18.3%
  Other                    1,439.00    62.0%   334.77      14.4%
Number of administere
  IV drugs (6)
  One                        998.14    54.2%   300.77      16.3%
  Two                      2,291.94    68.8%   456.61      13.7%
  Three                    1,023.01    43.5%   613.09      26.1%
  Four                     1,714.22    58.8%   699.57      24.0%

Category                  Other visit-related service

                            Average
                           costs ($)     %

Total                      568.72      24.1%
Age
  Less than 25             337.38      30.5%
  25 to 39                 495.38      22.8%
  40 to 54                 641.72      25.0%
  55 to 64                 776.50      24.1%
  Greater than 64          448.12      21.2%
Gender (2)
  Female                   527.57      24.6%
  Male                     557.15      26.9%
Region
  Midwest                  558.48      22.8%
  Northeast                501.61      22.4%
  South                    586.85      28.1%
  Southwest                339.75      20.3%
  West                     640.56      18.7%
Insurance type (3)
  Managed care             632.73      22.3%
  Medicare                 424.93      22.7%
  Medicare HMO             421.01      27.3%
  Medicaid                 422.96      49.2%
  Medicaid HMO             188.70      26.6%
  Indemnity                468.80      21.3%
  Other (4)                734.42      31.1%
IV drug (for mSTS) (5)
  Gemcitabine-b ased       495.59      15.1%
  Anthracycline-based      819.50      36.0%
  Alkylating-agents-based  548.39      39.3%
  Angiogenesis inhibitors  660.90      12.7%
  Taxane-based             448.37      20.9%
  Other                    545.96      23.5%
Number of administere
  IV drugs (6)
  One                      543.30      29.5%
  Two                      585.11      17.6%
  Three                    717.04      30.5%
  Four                     500.14      17.2%

(1): Treatment costs derived from the contracted
allowed payment for a claim.

(2): 644 patients were missing gender information.

(3): Insurance type is defined at the time of the index mSTS
diagnosis.

(4): Other includes workers' compensation, Tricare, and self-pay.

(5): Gemcitabine-based includes gemcitabine monotherapy
and combination therapies. Anthracycline-based includes doxorubicin
and epirubicin monotherapies and combination therapies.
Alkylating-agents-based includes monotherapies and combination
therapies with cisplatin, cyclophosphamide, dacarbazine, etoposide,
ifosfamide, temozolomide, and topotecan. Angiogenesis inhibitors
include bevacizumab monotherapy. Taxane-based includes docetaxel and
paclitaxel monotherapies and combination therapies. Other includes
actinomycin D, carboplatin, irinotecan, interferon, oxaliplatin,
vincristine, and vinorelbine.

(6): Number of mSTS treatments that were administered during the visit.
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Article Details
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Title Annotation:Research Article
Author:Duh, Mei Sheng; Hackshaw, Michelle D.; Ivanova, Jasmina I.; Kruse, Gregory; Miller, Lesley-Ann N.; L
Publication:Sarcoma
Article Type:Report
Date:Jan 1, 2014
Words:8899
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