Economic impact of sponsored clinical trials in treating patients with Malignant Pleural Mesothelioma

The current economic constraint pushes hospital management in using rationally the available public resources. This is even more relevant in patients with Malignant Pleural Mesothelioma (MPM) given the severity of the disease, its dismal prognosis and the cost of chemotherapy drugs. This work aims at evaluating the standard cost of patients with MPM, supporting physicians in their decision making process with respect the budget constraint. In particular, authors aim at comparing standard and experimental treatments, highlighting the main economic impact of these alternative pathways. We conducted a retrospective cost analysis, including all the patients with MPM undergoing their first medical accessin our Hospital between 2014 and 2015; collecting data about the diagnostic pathway and active treatments, as well as the relative official fees of each procedure. Afterwards, using a Regression based Cost Approach (RCA), we estimated the overall expected cost of a patient with MPM treated in our hospital, which would be supported by the Regional Health Care System according to the clinical pathways. Our analysis suggests that the economic impact of caring a patient with MPM is mostly related with the selected active treatments, with drug costs and hospitalizations as main drivers. Experimental trials could be a solution to decrease the economic burden of public health care systems only in first line treatments, where the cost of chemotherapy is relevant. At second and third line, even if drugs could be supplied free to the medical centers by the sponsor, there are not opportunities to save money.