Economic Burden of HR+/HER2- Metastatic Breast Cancer Among Adult Premenopausal Women
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Premenopausal women with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) have complex treatment needs and may receive sequential combinations of endocrine therapy (ET) or chemotherapy. This study describes healthcare utilization (HRU) and costs among premenopausal women with HR+/HER2- mBC in real-world settings from a payer’s perspective.
In this retrospective cohort study, premenopausal women with HR+/HER2- mBC who received ET or chemotherapy were identified from the Truven Health Analytics MarketScan database (1 January 2006–31 December 2015). The main HRU outcomes per patient per 6 months (PPP6 M) were measured during each line of therapy and included number of days in inpatient (IP) and outpatient (OP) services. Healthcare costs per patient per month (PPPM) included medical and pharmacy costs.
A total of 3203 patients received first-line, 2194 received second-line, and 1242 received third-line therapy for mBC. Mean number of IP days PPP6 M were 1.6, 1.3, and 1.5 days in the first, second, and third lines, respectively. Mean number of days with OP services PPP6 M was 31.4, 30.9, and 23.3 in the first, second, and third lines, respectively. Among patients receiving ET, mean total healthcare costs were $6521, $4440, and $4555 PPPM in the first, second, and third line, respectively. Among patients receiving chemotherapy, mean total healthcare costs were $16,842, $12,868, and $16,129 PPPM in the first, second, and third line, respectively. These costs were mainly driven by treatment and OP costs.
Real-world HRU and costs among premenopausal women with HR+/HER2- mBC are extensive. Patients who received chemotherapy incurred approximately twice the costs of patients treated with ET.
Novartis Pharmaceutical Corp.
KeywordsCosts Healthcare utilization Hormone positive Metastatic breast cancer Oncology Premenopausal
Sponsorship for this study (including article processing charges) was funded by Novartis Pharmaceuticals Corp.
Medical Writing, Editorial, and other Assistance
Medical writing assistance was provided by Sara Kaffashian, an employee of Analysis Group, Inc. Analysis Group received consulting fees from Novartis for the conduct of this study.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
The study sponsor was involved in all stages of the study research and manuscript preparation. All authors participated in the design and analytical approach of the study and contributed to the manuscript development. Results were summarized and interpreted in collaboration with all authors. The manuscript was prepared by the authors with assistance from a professional medical writer ultimately paid by the sponsor. Concept and design (GG, PG-S, AG, RB, TS, PN, AAD); acquisition of data (GG, PG-S, AG, RB, AAD); statistical analysis (GG, PG-S, AG, RB); interpretation of data (GG, PG-S, AG, RB, TS, PN, AAD); drafting of the manuscript (GG, PG-S, AG, RB); critical revision of the manuscript for important intellectual content (GG, PG-S, AG, RB, TS, PN, AAD).
Anand A. Dalal is an employee of Novartis Pharmaceuticals Corp. and may own stock/stock options. Tania Small is an employee of Novartis Pharmaceuticals Corp. and may own stock/stock options. Geneviève Gauthier is an employee of Analysis Group Inc., which has received consultancy fees from Novartis Pharmaceuticals Corp. Patrick Gagnon-Sanschagrin is an employee of Analysis Group Inc., which has received consultancy fees from Novartis Pharmaceuticals Corp. Annie Guérin is an employee of Analysis Group Inc., which has received consultancy fees from Novartis Pharmaceuticals Corp. Rebecca Burne is an employee of Analysis Group Inc., which has received consultancy fees from Novartis Pharmaceuticals Corp. Polly Niravath received honoraria from Novartis as a consultant.
Compliance with Ethics Guidelines
Data are de-identified and comply with the Health Insurance Portability and Accountability Act and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards and thus do not require ethics board review and approval.
The claims database (Truven MarketScan Commercial Database) is proprietary, provided by a third-party vendor, and the authors do not have permission to disseminate the data without the vendor's approval. Any researchers interested in obtaining the data for this study can access the data directly through Truven Health Analytics, Inc., under a license agreement, including the payment of appropriate license fees. Researchers can contact Truven at https://marketscan.truvenhealth.com/marketscanportal/.
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