POSB47 Hospital Management and Costs of Unresectable/Locally Advanced or Metastatic Esophageal Cancer in France (occasion Study)

To describe hospital resource utilization and costs for the management of patients with unresectable/locally advanced or metastatic esophageal cancer, eligible for a first-line treatment. An observational retrospective cohort study was conducted using the French exhaustive hospital discharge database (PMSI). Study population was identified through an algorithm based on expert inputs and combining criteria as ICD-10, surgery codes, treatment duration and stays in palliative care. Adults hospitalized with an ICD-10 code of esophageal cancer (C15 excluding C152) in 2015 and 2016 were included. Patients with a surgery were excluded, except those having a metastasis (C77-C79). Patient with a systemic anti-cancer therapy (SACT) less than 2 months or with at least one stay in palliative care were excluded, assuming weakness to receive SACT. Treatment was defined as chemotherapy (Z511) and first-line treatment was defined as the 0-6 months period after patient identification based on literature. Overall, 19,582 patients with unresectable/locally advanced or metastatic esophageal cancer were identified; 9,799 were considered eligible to receive a treatment. Among them, 4,032 received at least one chemotherapy session during the study period and 3,962 were treated in first line. These patients were aged 65.2±9.6 and 81.8% were men. 2-year mortality rate was 23%. 59,009 hospital stays were observed and distributed as 47% related to chemotherapy, 33% to radiotherapy and 20% for other reasons. Among chemotherapy sessions, 10% were associated with expensive drugs funded on top of DRG list. Chemotherapy and radiotherapy sessions were day hospitalization in majority and costed in average respectively 633.68±994.93€ and 270.41±351.05€ from NHI perspective and 1,038±684€ and 209±422€ from collective perspective. Transportation cost was estimated at 35.17€/session. This study showed that only 50% of patients with unresectable/locally advanced or metastatic esophageal cancer were eligible to receive a treatment and only 20% received at least one chemotherapy session.