Metformin & Non-Small Cell Lung Cancer Among Seer-Medicare Beneficiaries: Analysis of Cost, Outcomes & Utilization

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Ruban, C. (2017). Metformin & Non-Small Cell Lung Cancer Among Seer-Medicare Beneficiaries: Analysis of Cost, Outcomes & Utilization. Unc Charlotte Electronic Theses And Dissertations.
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Abstract

Type 2 diabetes (T2D) and non-small cell lung cancer (NSCLC) each represent costly chronic diseases with substantial public health implications. A better understanding of the relationship between T2D treatments and NSCLC has many important implications for prevention and management. There are several classes of antidiabetic drug medications (ADM), however this analysis will focus on metformin, which is a part of the biguanide drug class and generally first line therapy for T2D. This thesis is comprised of three studies that will utilize the Surveillance, Epidemiology, and End Results (SEER) Medicare database from 2007 to 2013 for NSCLC patients. The first study investigated the cost and utilization of diabetes patients with NSCLC. The adjusted analysis was performed using quantile regression for healthcare costs and a negative binomial model for healthcare utilization. Healthcare costs and utilization was higher in various healthcare settings for diabetic NSCLC patients compared to NSCLC Patients and increased with cancer stage. The second study measured the time to incident NSCLC diagnosis for metformin versus other antidiabetic drug medication (Thiazolidinedione, Sulfonylurea, Dipeptidyl peptidase-4 inhibitor). Kaplan-Meier method and log-rank tests were used to examine overall survival (time from incident medication to NSCLC diagnosis) for metformin and other antidiabetic drug medication users. Multivariable cox proportional hazards models were fit to assess the risk of NSCLC after incident medication utilization. Diabetic NSCLC patients with incident metformin had a significantly longer time to NSCLC diagnosis than NSCLC patients on other antidiabetic drug medication, prior to adjusting for covariates. The third study assessed the effect of metformin exposure on survival among patients with NSCLC diagnosis. Kaplan-Meier survival analysis was used to examine overall survival of metformin and other antidiabetic drug medication. NSCLC patients with incident metformin use, prior to and after NSCLC diagnosis did differ on survival compared to patients on other antidiabetic drug medications. The results from these three studies add to the body of literature on metformin and lung cancer. While findings did not support an effect on mortality, a delay in diagnosis was identified. While Aim 3 lacked statistical significance and the effect size was not meaningful, it has contributed a greater understanding of the association of metformin in NSCLC patients. Implications of study findings support the need for further exploration of the relationship between metformin and lung cancer.

Details
Author

Ruban, Cynthiya

Title

Metformin & Non-Small Cell Lung Cancer Among Seer-Medicare Beneficiaries: Analysis of Cost, Outcomes & Utilization

Physical Description

1 online resource (90 pages) : PDF

Date

2017

Degree Granting Institution

University of North Carolina at Charlotte

Abstract

Type 2 diabetes (T2D) and non-small cell lung cancer (NSCLC) each represent costly chronic diseases with substantial public health implications. A better understanding of the relationship between T2D treatments and NSCLC has many important implications for prevention and management. There are several classes of antidiabetic drug medications (ADM), however this analysis will focus on metformin, which is a part of the biguanide drug class and generally first line therapy for T2D. This thesis is comprised of three studies that will utilize the Surveillance, Epidemiology, and End Results (SEER) Medicare database from 2007 to 2013 for NSCLC patients. The first study investigated the cost and utilization of diabetes patients with NSCLC. The adjusted analysis was performed using quantile regression for healthcare costs and a negative binomial model for healthcare utilization. Healthcare costs and utilization was higher in various healthcare settings for diabetic NSCLC patients compared to NSCLC Patients and increased with cancer stage. The second study measured the time to incident NSCLC diagnosis for metformin versus other antidiabetic drug medication (Thiazolidinedione, Sulfonylurea, Dipeptidyl peptidase-4 inhibitor). Kaplan-Meier method and log-rank tests were used to examine overall survival (time from incident medication to NSCLC diagnosis) for metformin and other antidiabetic drug medication users. Multivariable cox proportional hazards models were fit to assess the risk of NSCLC after incident medication utilization. Diabetic NSCLC patients with incident metformin had a significantly longer time to NSCLC diagnosis than NSCLC patients on other antidiabetic drug medication, prior to adjusting for covariates. The third study assessed the effect of metformin exposure on survival among patients with NSCLC diagnosis. Kaplan-Meier survival analysis was used to examine overall survival of metformin and other antidiabetic drug medication. NSCLC patients with incident metformin use, prior to and after NSCLC diagnosis did differ on survival compared to patients on other antidiabetic drug medications. The results from these three studies add to the body of literature on metformin and lung cancer. While findings did not support an effect on mortality, a delay in diagnosis was identified. While Aim 3 lacked statistical significance and the effect size was not meaningful, it has contributed a greater understanding of the association of metformin in NSCLC patients. Implications of study findings support the need for further exploration of the relationship between metformin and lung cancer.

Genre

doctoral dissertations

Subjects--Topics

Medical sciences

Degree

Ph.D.

Keywords

Health Economic Outcomes Research
Non Small Cell Lung Cancer
Type 2 Diabetes

Subject Area

Health Services Research

Advisor(s)

Blanchette, Christopher

Committee Members

Kowalkowski, Marc
Marino, Joseph
Howden, Reuben
Saunders, William

Degree Note

Thesis (Ph.D.)--University of North Carolina at Charlotte, 2017.

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Rights Holder Information

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Identifier

Ruban_uncc_0694D_11548

Permalink

http://hdl.handle.net/20.500.13093/etd:1143