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The Economic Burden of Recurrence in Triple-Negative Breast Cancer Among Working Age Patients in the United States

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Abstract

Introduction

Triple-negative breast cancer (TNBC) is associated with a high recurrence risk. However, the magnitude of direct and indirect costs associated with recurrence is lacking in the literature.

Methods

Adults 18–65 years old diagnosed with TNBC were identified from the OptumHealth Reporting and Insights claims database (1999–2017) and stratified by recurrence. For patients with recurrence, the index date was defined as 30 days before recurrence; for patients without recurrence, it was randomly assigned based on the distribution of time between first treatments and index dates of the recurrence cohort. All-cause and breast cancer-related healthcare resource utilization (HRU), direct and indirect costs, and work loss up to 1 year were compared between cohorts using generalized linear models. Kaplan-Meier analyses and Cox proportional hazards models compared the risk of leaving the workforce.

Results

Among the 2340 patients analyzed, mean age was 54 years and > 75% of patients had stage 0–2 cancer. Among the 1170 patients with recurrence, 236 were categorized as having metastatic recurrence and 934 as having locoregional recurrence. Relative to patients without recurrence, those with recurrence had significantly higher all-cause and breast cancer-related HRU. For instance, adjusted incidence rates (IRs) for all-cause inpatient admissions were 3.67 and 10.19 times higher for patients with locoregional and metastatic recurrence, respectively (p < 0.001). Adjusted all-cause healthcare costs were $8575/month higher for metastatic recurrence and $3609/month higher for locoregional recurrence vs. patients without recurrence (p < 0.001). Adjusted IRs for work loss days were approximately two times higher for locoregional and metastatic recurrence vs. without recurrence (p < 0.001). Patients with locoregional recurrence incurred $335/month more indirect costs vs. patients without recurrence; those with metastatic recurrence incurred $769/month more (p < 0.05). Patients with recurrence had a 63% higher rate of leaving the work force (p = 0.003).

Conclusion

The incremental direct and indirect economic burden associated with recurrent TNBC is substantial relative to non-recurrence.

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Acknowledgements

Funding

Sponsorship for this study and the journal’s Rapid Service Fee were funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA Authorship.

Editorial Assistance

Editorial assistance in the preparation of this article was provided by Gloria DeWalt, PhD, of Analysis Group, Inc. Support for this assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

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. All authors read and approved the final manuscript.

Author Contributions

Jan Sieluk, Yan Song, Jonathan Freimark, Min Huang, Amin Haiderali, Richard Berman, Travis Wang, James Signorovitch, and Kim Marie Hirshfield contributed to the study conception, design, material preparation, data collection and analysis, and manuscript composition and editing.

Prior Presentation

A synopsis of the study’s results was presented at The Professional Society for Health Economics and Outcomes Research (ISPOR) virtual congress May 17–20, 2021.

Disclosures

Jan Sieluk, Min Huang, Amin Haiderali, and Kim Marie Hirshfield are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and may own stock/stock options in Merck & Co., Inc., Kenilworth, NJ, USA, Yan Song, Jonathan Freimark, Richard Berman, Travis Wang, and James Signorovitch are employees of Analysis Group, Inc., which received consulting fees from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, for the conduct of this study.

Compliance with Ethics Guidelines

Ethics board approval was not required for this study as the pre-existing data used were de-identified and fully compliant with The Health Insurance Portability and Accountability Act of 1996 and was performed in accordance with the Helsinki Declaration of 1964 and its later amendments.

Data Availability

The data used in this study were obtained via licensing agreement with Optum and are not publicly available.

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Authors and Affiliations

  1. Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA

    Jan Sieluk, Min Huang, Amin Haiderali & Kim Marie Hirshfield

  2. Analysis Group, Inc., Boston, MA, USA

    Yan Song, Jonathan Freimark, Richard Berman, Travis Wang & James Signorovitch

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  1. Jan Sieluk
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Correspondence to Jan Sieluk.

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Sieluk, J., Song, Y., Freimark, J. et al. The Economic Burden of Recurrence in Triple-Negative Breast Cancer Among Working Age Patients in the United States. Adv Ther 39, 943–958 (2022). https://doi.org/10.1007/s12325-021-01913-5

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  • DOI: https://doi.org/10.1007/s12325-021-01913-5

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