Healthcare costs in women with metastatic breast cancer receiving chemotherapy as their principal treatment modality

BMC Cancer

Gerry Oster²  Angie Qin²  Rohit Borker³  Sue Gao³  Andrew Glass¹  Derek Weycker²  Montserrat Vera-Llonch² 

[1]Kaiser Permanente Northwest, Portland, OR, USA

[2]Policy Analysis Inc (PAI), Brookline, MA, USA

[3]Amgen Inc, Thousand Oaks, CA, USA

关键词: burden of illness;    chemotherapy;    metastatic breast cancer;    Cost;   

Others  :  1080885
DOI  :  10.1186/1471-2407-11-250

 received in 2010-09-02, accepted in 2011-06-15,  发布年份 2011

【 摘 要 】

Background

The economic costs of treating patients with metastatic breast cancer have been examined in several studies, but available estimates of economic burden are at least a decade old. In this study, we characterize healthcare utilization and costs in the US among women with metastatic breast cancer receiving chemotherapy as their principal treatment modality.

Methods

Using a large private health insurance claims database (2000-2006), we identified all women initiating chemotherapy for metastatic breast cancer with no evidence of receipt of concomitant or subsequent hormonal therapy, or receipt of trastuzumab at anytime. Healthcare utilization and costs (inpatient, outpatient, medication) were estimated on a cumulative basis from date of chemotherapy initiation ("index date") to date of disenrollment from the health plan or the end of the study period, whichever occurred first. Study measures were cumulated over time using the Kaplan-Meier Sample Average (KMSA) method; 95% CIs were generated using nonparametric bootstrapping. Findings also were examined among the subgroup of patients with uncensored data.

Results

The study population consisted of 1444 women; mean (SD) age was 59.1 (12.1) years. Over a mean follow-up of 532 days (range: 3 to 2412), study subjects averaged 1.7 hospital admissions, 10.7 inpatient days, and 83.6 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $128,556 ($118,409, $137,644) per patient. Outpatient services accounted for 29% of total costs, followed by medication other than chemotherapy (26%), chemotherapy (25%), and inpatient care (20%).

Conclusions

Healthcare costs-especially in the outpatient setting--are substantial among women with metastatic breast cancer for whom treatment options other than chemotherapy are limited.

【 授权许可】

   
2011 Vera-Llonch et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]American Cancer Society, Inc., Surveillance and Health Policy Research [http:/ / www.cancer.org/ Research/ ResearchProgramsFunding/ SurveillanceandHealthPolicyResearch / index] webcite
• [2]Honig SF: Hormonal therapy and chemotherapy. In Diseases of the Breast. Edited by Harris JR, Lippman ME, Morrow M, Osborne CK. Philadelphia: Lippincott-Raven Publishers; 1996:669-734.
• [3]Glass AG, Lacey JV, Carreon JD, Hoover RN: Breast cancer incidence, 1980-2006: Combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst 2007, 99:1152-1161.
• [4]Rastelli F, Crispino S: Factors predictive of response to hormone therapy in breast cancer. Tumori 2008, 94:370-383.
• [5]Hortobagyi GN: Drug therapy: Treatment of breast cancer. N Engl J Med 1998, 339:974-984.
• [6]Higgins MJ, Wolff AC: Therapeutic options in the management of metastatic breast cancer. In Oncology. Volume 22. Williston Park; 2008::614-623. discussion 623, 627-629
• [7]Isakoff SJ: Triple-negative breast cancer: role of specific chemotherapy agents. Cancer J 2010, 16:53-61.
• [8]Wilcken N, Hornbuckle J, Ghersi D: Chemotherapy alone versus endocrine therapy alone for metastatic breast cancer. Cochrane Database Syst Rev 2003, 2:CD002747.
• [9]Conlin AK, Seidman AD: Beyond cytotoxic chemotherapy for the first-line treatment of HER2-negative, hormone-insensitive metastatic breast cancer: current status and future opportunities. Clin Breast Cancer 2008, 8:215-223.
• [10]Sørlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, Thorsen T, Quist H, Matese JC, Brown PO, Botstein D, Eystein Lønning P, Børresen-Dale AL: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 2001, 98:10869-10874.
• [11]Sorlie T, Tibshirani R, Parker J, Hastie T, Marron JS, Nobel A, Deng S, Johnsen H, Pesich R, Geisler S, Demeter J, Perou CM, Lønning PE, Brown PO, Børresen-Dale AL, Botstein D: Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 2003, 100:8418-8423.
• [12]Sotiriou C, Neo SY, McShane LM, Korn EL, Long PM, Jazaeri A, Martiat P, Fox SB, Harris AL, Liu ET: Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci USA 2003, 100:10393-10398.
• [13]Campbell JD, Ramsey SD: The costs of treating breast cancer in the US. Pharmacoeconomics 2009, 27:199-209.
• [14]Max W, Sung HY, Stark B: The economic burden of breast cancer in California. Breast Cancer Res Treat 2009, 116:201-207.
• [15]Barron JJ, Quimbo R, Nikam PT, Amonkar MM: Assessing the economic burden of breast cancer in a US managed care population. Breast Cancer Res Treat 2008, 109:367-377.
• [16]Rao S, Kubisiak J, Gilden D: Cost of illness associated with metastatic breast cancer. Breast Cancer Res Treat 2004, 83:25-32.
• [17]Berkowitz N, Gupta S, Silberman G: Estimates of the lifetime direct costs of treatment for metastatic breast cancer. Value Health 2000, 3:23-30.
• [18]Lin DY, Feuer EJ, Etzioni R, Wax Y: Estimating medical costs from incomplete follow-up data. Biometrics 1997, 53:419-434.
• [19]Efron B: Bootstrap Methods: Another look at the jackknife. Ann Statist 1979, 7:1-26.
• [20]Legorreta AP, Brooks RJ, Leibowitz AN, Solin LJ: Cost of breast cancer treatment: A 4-year longitudinal study. Arch Intern Med 1996, 156:2197-2201.
• [21]Taplin SH, Barlow W, Urban N, Mandelson MT, Timlin DJ, Ichikawa L, Nefcy P: Stage, age, comorbidity and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 1995, 87:417-426.
• [22]Cooper GS, Yuan Z, Stange KC, Amini SB, Dennis LK, Rimm AA: The utility of Medicare claims for measuring cancer stage. Med Care 1999, 37:706-711.
• [23]Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, Lickley LA, Rawlinson E, Sun P, Narod SA: Triple-negative breast cancer: clinical features and patterns of recurrent. Clin Cancer Res 2007, 13:4429-4434.