국내 위암 환자에게 투여되는 항암제 처방 양상 및 의료비용 분석: Ramucirumab 급여 전후 비교 중심으로

Abstract

Objectives: This study aimed to analyze the change in treatment patterns and medical expenditures of patients with gastric cancer in South Korea by focusing on a comparison before and after the listing of Ramucirumab in insurance coverage in 2018. Methods: This study used the Health Insurance Review & Assessment Service–National Patients Sample (HIRA-NPS) database to identify patients (aged ≥20 years) with gastric cancer (ICD-10 code: C16) from 1st Jan 2016 to 31st Dec 2020. This study included 8 types of cytotoxic anticancer drugs (Fluorouracil, Capecitabine, TS-1 [Tegafur+Gimeracil+Oteracil potassium], Paclitaxel, Docetaxel, Oxaliplatin, Cisplatin, Irinotecan) and 2 types of targeted therapy (Trastuzumab, Ramucirumab). The treatment patterns and drug costs were analyzed according to the drug types. In addition, the status of medical expenditures per patient was presented by regions, medical institutions, and specialties using the t-test. Results: In the analysis, combination therapy was prescribed for about 69% (5-year average value) of patients with gastric cancer, and among them, double therapy was prescribed for 89%. As double therapy, XELOX (Oxaliplatin+Capecitabine), mainly used for first-line treatment or adjuvant therapy, accounted for the highest value of about 60%. For second-line treatment, Fluorouracil+Irinotecan had been mostly used until 2017, and Ramucirumab+Paclitaxel after 2018. In addition, the drug cost of targeted therapy had significantly increased by about 23%p from 15.89% in 2017 to 39.21% in 2018. As a result of the t-test, the regions and medical institutions had no impact on medical expenditures, but just the specialties had an impact. Conclusion: The paradigm of prescription patterns for second-line treatment of gastric cancer and drug costs has changed since Ramucirumab was listed in insurance coverage in 2018.