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HER2-Positive Metastatic Breast Cancer: A Retrospective Cohort Study of Healthcare Costs in the Targeted-Therapy Age

Abstract

Introduction

Claims data (IBM MarketScan Commercial and MarketScan Medicare Supplemental databases) from June 30, 2011 to September 30, 2017 were used to evaluate the cost impact of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) in this retrospective cohort study.

Methods

The primary analysis compared short-term costs for patients diagnosed with HER2+ MBC at least 180 days after the end of first HER2-targeted treatment (MBC+ cohort) versus a propensity score matched cohort of patients with breast cancer who did not develop MBC (MBC− cohort). A pseudo-post period for patients in the HER2+ MBC− cohort was defined by indexing to the HER2+ treatment completion–MBC diagnosis time interval of the matched pair in the HER2+ MBC+ cohort; we then compared average monthly cost differences between these groups for the year preceding and following MBC diagnosis. In secondary analyses, we estimated medium-term aggregate and categorical healthcare costs for patients with HER2+ MBC up to 3 years post-diagnosis.

Results

In the short-term primary analysis, costs for the HER2+ MBC+ and HER2+ MBC− cohorts were largely comparable in the year preceding MBC diagnosis. Monthly direct costs were significantly higher for the HER2+ MBC+ cohort in the months immediately preceding MBC diagnosis, with differences in the range of $500–5000. Following diagnosis, total monthly costs were $13,000–34,000 higher for patients in the HER2+ MBC+ cohort vs. the HER2+ MBC− cohort. In the medium-term secondary analysis, mean per patient total costs were $218,171 [standard error (SE) $5450] in the first year following MBC diagnosis and $412,903 (SE $13,034) cumulatively over 3 years following diagnosis (among patients with complete follow-up). Primary cost contributors were outpatient visits ($195,162; SE $8043) and HER2-targeted therapy drug costs ($177,489; SE $8120).

Conclusions

HER2+ MBC is associated with high short-term and medium-term direct healthcare costs. These could be alleviated with early diagnosis and optimal standard-of-care treatment for early breast cancer, which can significantly reduce the risk of recurrence.

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Acknowledgements

Funding

This work and its publication was supported by F. Hoffmann-La Roche/Genentech, Inc. The study sponsor was involved in data collection, analysis, and interpretation, and writing of this report. The authors, who are employees or contracted employees of the sponsor, prepared the manuscript draft, with support from a sponsor-funded medical writer. All authors had full access to all data, were involved in data analysis/interpretation, contributed to subsequent manuscript drafting, made the final decision to submit this manuscript for publication, and vouch for the accuracy and completeness of the report. The study sponsor also funded the journal’s Rapid Service fee.

Medical Writing Assistance

Support for third-party writing assistance was provided by Meredith Kalish, MD, from Ashfield Healthcare Communications (a UDG Healthcare plc company), and funded by F. Hoffmann-La Roche/Genentech, Inc.

Authorship

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.

Disclosures

Jesse A. Sussell and Arpamas Seetasith are employees of Genentech, Inc. and own stock in F. Hoffmann-La Roche. Daniel Sheinson is an employee of Genentech, Inc. and owns stock in Cigna Corp and F. Hoffmann-La Roche. Ning Wu and Bijal Shah-Manek worked as consultants for Genentech, Inc. to conduct the study reported in this manuscript; Ning Wu is currently affiliated with Biogen. All authors received non-financial support from F. Hoffmann-La Roche in the form of medical writing support for this manuscript.

Prior Presentation

Data reported in this manuscript were partially presented in an abstract at the 2018 American Society of Clinical Oncology Annual Meeting: Goertz H-P, Sheinson D, Wu N. Relationship of healthcare costs and disease progression in patients with HER2+ breast cancer. Journal of Clinical Oncology 36, no. 15_suppl.

Compliance with Ethics Guidelines

This was a retrospective analysis of completely de-identified healthcare claims data purchased from a commercial vendor; identification of individual patients (either directly or through the use of linked identifiers) was impossible. Therefore, the study was exempt from human subject regulations, and review by an institutional review board was not required.

Data Availability

The datasets analyzed during the current study are not publicly available because they were derived from commercially acquired healthcare claims data; sharing would violate the terms of existing data license agreements.

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Correspondence to Jesse A. Sussell.

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Sussell, J.A., Sheinson, D., Wu, N. et al. HER2-Positive Metastatic Breast Cancer: A Retrospective Cohort Study of Healthcare Costs in the Targeted-Therapy Age. Adv Ther 37, 1632–1645 (2020). https://doi.org/10.1007/s12325-020-01283-4

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Keywords

  • Breast cancer
  • Cancer care/oncology
  • Cost effectiveness/cost analysis
  • Costs of care/healthcare expenditures
  • Drug therapy