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Medical costs associated with metastatic breast cancer in younger, midlife, and older women

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Abstract

Purpose

We estimated average medical costs due to metastatic breast cancer (mBC) among younger (aged 18–44), midlife (aged 45–64), and older women (aged 65 and older) by phase of care: initial, continuing, and terminal.

Methods

We used 2003–2014 North Carolina cancer registry data linked with administrative claims from public and private payers. We developed a claims-based algorithm to identify breast cancer patients who progressed to metastatic disease. We matched breast cancer patients (mBC and earlier stage) to non-cancer patients on age group, county of residence, and insurance plan. Outcomes were average monthly medical expenditures and expected medical expenditures by phase. We used regression to estimate excess costs attributed to mBC as the difference in mean payments between patients with mBC (N = 4806) and patients with each earlier-stage breast cancer (stage 1, stage 2, stage 3, and unknown stage; N = 21,772) and non-cancer controls (N = 109,631) by treatment phase and age group.

Results

Adjusted monthly costs for women with mBC were significantly higher than for women with earlier-stage breast cancer and non-cancer controls for all age groups and treatment phases except the initial treatment among women with stage 3 breast cancer at diagnosis. The largest expected total costs were for women aged 18–44 with mBC during the continuing phase ($209,961 95% Confidence Interval $165,736–254,186).

Conclusions

We found substantial excess costs for mBC among younger women and during the continuing and terminal phases of survivorship. It is important to assess whether this care is high value for these women.

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Funding

This research was support by the Centers for Disease Control and Prevention (SIP 17–004; PIs: Trogdon and Wheeler). The database infrastructure used for this project was supported through the UNC Lineberger Comprehensive Cancer Center, University Cancer Research Fund via the State of North Carolina.

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Authors and Affiliations

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Justin G. Trogdon, Anagha Gogate, Jason Rotter & Stephanie B. Wheeler

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Justin G. Trogdon, Christopher D. Baggett, Katherine E. Reeder-Hayes, Xi Zhou & Stephanie B. Wheeler

  3. Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Justin G. Trogdon & Stephanie B. Wheeler

  4. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Christopher D. Baggett

  5. Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes

  6. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Donatus U. Ekwueme & Temeika L. Fairley

Authors
  1. Justin G. Trogdon
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  2. Christopher D. Baggett
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  3. Anagha Gogate
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  4. Katherine E. Reeder-Hayes
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  5. Jason Rotter
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  6. Xi Zhou
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  7. Donatus U. Ekwueme
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  9. Stephanie B. Wheeler
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Contributions

Conceptualization: JGT, DUE, TLF, SBW; Data curation: CDB, XZ; Formal analysis: AG, JR, XZ; Funding acquisition: JGT, DUE, TLF, SBW; Investigation: JGT, KERH, SBW; Methodology: JGT, KERH, JR, SBW; Project administration: JGT, CDB, DUE, SBW; Resources: CDB, DUE, TLF; Software: CDB, XZ; Supervision: JGT, DUE, SBW; Validation: JGT, CDB, JR, XZ, SBW; Visualization: JGT, JR, SBW; Writing—original draft: JGT, AG, JR, SBW; Writing—review and editing: JGT, AG, KERH, JR, DUE, TLF, SBW.

Corresponding author

Correspondence to Justin G. Trogdon.

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Conflicts of interest

Dr. Trogdon worked with the Centers for Disease Control and Prevention under Intergovernmental Personnel Act 15IPA1504755. Drs. Wheeler and Reeder-Hayes received grant funding paid to their institution from Pfizer Foundation in the past 3 years. Ms. Gogate holds a pre-doctoral fellowship position with Bristol-Myers Squibb Company for work external to this study. All other authors report no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the University of North Carolina IRB #17-2604.

Research involving human and animal rights

This article does not contain any studies with animals performed by any of the authors.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Appendix

Appendix

See Tables 3 and 4.

Table 3 International classification of diseases (9th edition) and national drug codes used in progression to metastatic breast cancer algorithm
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Table 4 Exponentiated regression coefficients from generalized estimating equations with log link and gamma family [95% confidence interval]
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Trogdon, J.G., Baggett, C.D., Gogate, A. et al. Medical costs associated with metastatic breast cancer in younger, midlife, and older women. Breast Cancer Res Treat 181, 653–665 (2020). https://doi.org/10.1007/s10549-020-05654-x

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