San Antonio, TX—Healthcare costs increase after progression to chemotherapy among postmenopausal pa tients with hormone-sensitive metastatic breast cancer, although ambulatory care drives the cost before and after progression, data from a retrospective chart review showed, as reported at the San Antonio Breast Cancer Symposium.
Six-month costs increased by almost 50% after progression, and the 2- and 3-year costs were more than twice as high compared with the same length of observation before progression.
An analysis of individual cost contributors showed that ambulatory care accounted for 60% to 70% of total monthly costs before and after progression to chemotherapy.
No other type of healthcare expenditure, including pharmacy, accounted for as much as 10% of the total cost.
“Both before and after progression to chemotherapy, ambulatory care is the principal driver of healthcare costs,” said Kim Lew, PharmD, of Amgen in Thousand Oaks, CA. “This issue had not been studied in great detail, and these findings might be helpful in evaluating the risks and benefits of therapy for this subgroup of breast cancer patients.” Hormone Receptor Status Affects Treatment Decisions Treatment decisions in the setting of metastatic breast cancer are strongly influenced by a tumor’s hormone receptor status. For patients with receptor-positive tumors, hormonal therapy offers effective tumor control for many patients and is less toxic compared with chemotherapy.
For reasons that are not completely understood, some receptor-positive tumors do not respond to hormonal therapy (de novo resistance). In other cases, hormone-sensitive tumors develop acquired resistance to endocrine therapy. Either type of patient might be a candidate for cytotoxic chemotherapy, which is associated with a variety of adverse effects, including some serious and potentially lifethreatening effects.
The investigators sought to quantify the direct healthcare costs associated with managing metastatic postmenopausal receptor-positive breast cancer before and after progression to chemotherapy. They retrospectively reviewed claims for women aged 55 to 63 years with a diagnosis of metastatic breast cancer from July 2001 through December 2007.
The final analysis included 1202 patients, of whom 366 (30.4%) pro gressed to chemotherapy. Each patient was followed until disenrollment from the health plan, death, or Decem ber 2008.
Annual costs incurred during the prechemotherapy period averaged $79,139 compared with $132,796 after initiation of chemotherapy. Medical costs accounted for $74,149 per patient-year during the prechemotherapy period and $120,942 in the postchemo therapy period. Pharmacy costs accounted for the remaining $4990 per patient-year in the prechemotherapy group and $11,843 after initiation of chemotherapy.
Further analysis showed that medical costs associated with ambulatory care averaged $44,405 annually and $87,299 annually before and after initiation of chemotherapy, respectively. Inpatient costs averaged $27,147 and $30,118 in the pre- and postchemotherapy periods.
After adjustment for duration of follow- up, total healthcare costs averaged $54,725, $73,107, and $84,200 during years 1, 2, and 3 of the prechemotherapy period compared with $92,639, $148,228, and $176,163 for the same duration of follow-up after initiation of chemotherapy.