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.
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.
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).
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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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.
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.
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.
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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