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Real-World Analysis of Medical Costs and Healthcare Resource Utilization in Elderly Women with HR+/HER2− Metastatic Breast Cancer Receiving Everolimus-Based Therapy or Chemotherapy

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Abstract

Introduction

The objective of this study was to analyze medical costs and healthcare resource utilization (HRU) associated with everolimus-based therapy or chemotherapy among elderly women with hormone-receptor-positive, human-epidermal-growth-factor-receptor-2-negative (HR+/HER2−) metastatic breast cancer (mBC).

Methods

Elderly women (≥65 years) with HR+/HER2− mBC who failed a non-steroidal-aromatase-inhibitor and subsequently began a new line of treatment with everolimus-based therapy or chemotherapy for mBC (index therapy) during July 20, 2012 to March 31, 2014 were identified from two large commercial claims databases. All-cause, BC-, and adverse event (AE)-related medical costs (2014 USD), and all-cause and AE-related HRU per patient per month (PPPM) were compared between patients treated with everolimus-based therapy and chemotherapy across their first four lines of therapy for mBC. Adjusted costs and HRU differences were estimated by pooling all lines and using multivariable models adjusted for differences in patient characteristics.

Results

In total, 925 elderly patients (mean age approximately 73 years) with HR+/HER2− mBC met the inclusion criteria; 230 received everolimus-based therapy (240 lines) and 737 received chemotherapy (939 lines). Compared with chemotherapy, everolimus-based therapy was associated with significantly lower total all-cause PPPM medical services costs (adjusted mean difference: $4007), driven by lower inpatient ($1994) and outpatient ($1402) costs; lower BC-related medical services costs ($3129), driven by both BC-related inpatient ($1883) and outpatient costs ($913); and lower AE-related medical services costs ($1873; all P < 0.01). Additionally, compared to patients treated with chemotherapy, patients treated with everolimus-based therapy had fewer all-cause outpatient visits (adjusted incidence rate ratio = 0.69), BC-related outpatient visits (0.66), other-medical-service visits (0.65), and AE-related HRU (0.59), which was driven by significantly fewer AE-related outpatient visits (0.56; all P < 0.01). Subgroup analyses comparing medical costs of everolimus-based therapy with capecitabine monotherapy showed consistent results overall.

Conclusion

This retrospective claims database analysis of elderly women with HR+/HER2− mBC in the United States showed that everolimus-based therapy was associated with significantly lower all-cause, BC-related, and AE-related medical services costs and less use of healthcare resources compared with chemotherapy.

Funding

Novartis.

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References

  1. World Health Organization. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevelance worldwide in 2012. Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed 26 Oct 2015.

  2. Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol. 2007;8(12):1101–15.

    Article  PubMed  Google Scholar 

  3. Cardoso F, Harbeck N, Fallowfield L, Kyriakides S, Senkus E, Group EGW. Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol ESMO. 2012; 23(Suppl 7):vii11–9.

  4. Lu J, Steeg PS, Price JE, Krishnamurthy S, Mani SA, Reuben J, et al. Breast cancer metastasis: challenges and opportunities. Cancer Res. 2009;69(12):4951–3.

    Article  CAS  PubMed  Google Scholar 

  5. Muss HB, Busby-Whitehead J. Older women with breast cancer: slow progress, great opportunity, now is the time. J Clin Oncol. 2011;29(35):4608–10.

    Article  PubMed  Google Scholar 

  6. van de Water W, Markopoulos C, van de Velde CJ, Seynaeve C, Hasenburg A, Rea D, et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer. JAMA. 2012;307(6):590–7.

    Article  CAS  PubMed  Google Scholar 

  7. Riseberg D. Treating Elderly patients with hormone receptor-positive advanced breast cancer. Clin Med Insights Oncol. 2015;9:65–73.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yardley DA. Taxanes in the elderly patient with metastatic breast cancer. Breast cancer. 2015;7:293–301.

    PubMed  PubMed Central  Google Scholar 

  9. Howlader N, Altekruse SF, Li CI, Chen VW, Clarke CA, Ries LA, et al. US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst. 2014;106(5).

  10. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341(27):2061–7.

    Article  CAS  PubMed  Google Scholar 

  11. National Comprehensive Cancer Network. Breast Cancer, Version 2.2015: National Comprehensive Cancer Network (NCCN); 2015 [21 May 2015]. 184. Available from: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 26 Oct 2015.

  12. Vera-Llonch M, Weycker D, Glass A, Gao S, Borker R, Qin A, et al. Healthcare costs in women with metastatic breast cancer receiving chemotherapy as their principal treatment modality. BMC Cancer. 2011;11:250.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Aapro M, Bernard-Marty C, Brain EG, Batist G, Erdkamp F, Krzemieniecki K, et al. Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper. Ann Oncol. 2011;22(2):257–67.

    Article  CAS  PubMed  Google Scholar 

  14. Baselga J, Campone M, Piccart M, Burris HA, Rugo HS, Sahmoud T, et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. New Engl J Med. 2012;366(6):520–9.

    Article  CAS  PubMed  Google Scholar 

  15. Baselga J, Campone M, Piccart M, Burris HA 3rd, Rugo HS, Sahmoud T, et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med. 2012;366(6):520–9.

    Article  CAS  PubMed  Google Scholar 

  16. Pritchard KI, Burris HA, 3rd, Ito Y, Rugo HS, Dakhil S, Hortobagyi GN, et al. Safety and efficacy of everolimus with exemestane vs. exemestane alone in elderly patients with HER2-negative, hormone receptor-positive breast cancer in BOLERO-2. Clin Breast Cancer. 2013;13(6):421–32 e8.

  17. Rugo HS, Pritchard KI, Gnant M, Noguchi S, Piccart M, Hortobagyi G, et al. Incidence and time course of everolimus-related adverse events in postmenopausal women with hormone receptor-positive advanced breast cancer: insights from BOLERO-2. Ann Oncol. 2014;25(4):808–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Pawaskar MKS, Dalvi T, et al.Health care utilization and costs among HER2-negative, HR-positive, elderly women with metastatic breast cancer in the United States, abstr ASCO Annual Meeting, Chicago, IL. J Clin Oncol. 2013 (suppl; abstr e11571)

  19. Xie J, Hao Y, Zhou ZY, Qi CZ, De G, Gluck S. Economic evaluations of everolimus versus other hormonal therapies in the treatment of HR/HER2 Advanced Breast Cancer From a US Payer Perspective. Clin Breast Cancer. 2015;15:e263–76.

    Article  CAS  PubMed  Google Scholar 

  20. Kourlaba G, Rapti V, Alexopoulos A, Relakis J, Koumakis G, Chatzikou M, et al. Everolimus plus exemestane versus bevacizumab-based chemotherapy for second-line treatment of hormone receptor-positive metastatic breast cancer in Greece: An economic evaluation study. BMC Health Serv Res. 2015;15:307.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Li N, Hao Y, Koo V, Fang A, Peeples M, Kageleiry A, et al. Comparison of medical costs and healthcare resource utilization of post-menopausal women with HR+/HER2- metastatic breast cancer receiving everolimus-based therapy or chemotherapy: A retrospective claims database analysis. 2016 NCCN Annual Meeting; Hollywood, FL during March 31-April 2, 2016.

  22. Gelmon K, Chan A, Harbeck N. The role of capecitabine in first-line treatment for patients with metastatic breast cancer. Oncologist. 2006;11(Suppl 1):42–51.

    Article  CAS  PubMed  Google Scholar 

  23. Wang Y, Yang H, Wei JF, Meng L. Efficacy and toxicity of capecitabine-based chemotherapy in patients with metastatic or advanced breast cancer: results from ten randomized trials. Curr Med Res Opin. 2012;28(12):1911–9.

    Article  CAS  PubMed  Google Scholar 

  24. Blum JL, Barrios CH, Feldman N, Verma S, McKenna EF, Lee LF, et al. Pooled analysis of individual patient data from capecitabine monotherapy clinical trials in locally advanced or metastatic breast cancer. Breast Cancer Res Treat. 2012;136(3):777–88.

    Article  CAS  PubMed  Google Scholar 

  25. Swallow E, Zhang J, Thomason D, Tan RD, Kageleiry A, Signorovitch J. Real-world patterns of endocrine therapy for metastatic hormone-receptor-positive (HR+)/human epidermal growth factor receptor-2-negative (HER2-) breast cancer patients in the United States: 2002–2012. Curr Med Res Opin. 2014;30(8):1537–45.

    Article  CAS  PubMed  Google Scholar 

  26. Whyte JL, Engel-Nitz NM, Teitelbaum A, Gomez Rey G, Kallich JD. An evaluation of algorithms for identifying metastatic breast, lung, or colorectal cancer in administrative claims data. Med Care. 2015;53(7):e49–57.

    Article  PubMed  Google Scholar 

  27. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  PubMed  Google Scholar 

  28. Xie J, Diener M, De G, Yang H, Wu EQ, Namjoshi M. Budget impact analysis of everolimus for the treatment of hormone receptor positive, human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer in the United States. J Med Econ. 2013;16(2):278–88.

    Article  PubMed  Google Scholar 

  29. Lewis L, Taylor M, Suriya Ertugyrovna Y, Kuanysh Shadybayevich N, Kaldygul Kabakovna S, Ramil Zufarovich A. Budget impact analysis of everolimus for the treatment of hormone receptor positive, human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer in Kazakhstan. J Med Econ. 2015;18(3):189–99.

    Article  PubMed  Google Scholar 

  30. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst. 2011;103(2):117–28.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Generali D, Venturini S, Rognoni C, Ciani O, Pusztai L, Loi S, et al. A network meta-analysis of everolimus plus exemestane versus chemotherapy in the first- and second-line treatment of estrogen receptor-positive metastatic breast cancer. Breast Cancer Res Treat. 2015;152(1):95–117.

    Article  CAS  PubMed  Google Scholar 

  32. Li N, Hao Y, Xie J, Lin PL, Koo V, Ohashi E, et al. Everolimus-based therapy versus chemotherapy among patients with HR+/HER2− metastatic breast cancer: comparative effectiveness from a chart review study. Int J Breast Cancer. 2015;2015:1–9.

    Article  Google Scholar 

Download references

Acknowledgments

Funding for this research was provided by Novartis. The article processing charges for this publication were funded by Novartis. Manuscript drafts were prepared by the authors with editorial assistance from Shelley Batts, Ph.D., a professional medical writer for Analysis Group, Inc. ultimately paid by the sponsor, Novartis. The study sponsor, Novartis, was involved in all stages of the study research and manuscript preparation, but all authors participated in the design of the study and contributed to the manuscript development. Data were collected by Analysis Group and analyzed and interpreted in collaboration with all other authors. All the authors vouch for the accuracy and completeness of the data reported and the adherence of the study to the protocol, and all the authors made the decision to submit the manuscript for publication. Furthermore, all named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. A synopsis of the current research has been submitted to the International Society for Pharmacoeconomics and Outcomes Research Annual International Meeting, which will take place in Washington, DC during May 21–25, 2016.

Disclosures

Yanni Hao is an employee of Novartis and owns stock/stock options. Nanxin Li, Anna P. Fang, Valerie Koo, Miranda Peeples, Andrew Kageleiry, Eric Q. Wu, and Annie Guérin are employees of Analysis Group Inc., which has received consultancy fees from Novartis.

Compliance with Ethics Guidelines

The patient data were de-identified and complied with the patient confidentiality requirements of the Health Insurance Portability and Accountability Act. Ethical review was not required.

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Correspondence to Annie Guérin.

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Hao, Y., Li, N., Fang, A.P. et al. Real-World Analysis of Medical Costs and Healthcare Resource Utilization in Elderly Women with HR+/HER2− Metastatic Breast Cancer Receiving Everolimus-Based Therapy or Chemotherapy. Adv Ther 33, 983–997 (2016). https://doi.org/10.1007/s12325-016-0328-3

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