Chemotherapy-Related Toxicity Adds to Economic Burden in Metastatic Breast Cancer

August 2012 Vol 5, No 5, Special Issue ASCO 2012 Payers' Perspective - Breast Cancer
Caroline Helwick

Chicago, IL—Adverse events related to chemotherapy for metastatic breast cancer lead to a substantial economic burden that is primarily ex­plained by increased inpatient, outpatient, and pharmacy costs, said lead investigator Sara A. Hurvitz, MD, Director of the Oncology Breast Can­cer Program at University of Califor­nia, Los Angeles (UCLA) Jonsson Compre­hensive Cancer Center and Assistant Clinical Professor at UCLA School of Medicine, who presented an economic analysis at ASCO 2012.

“An analysis of healthcare costs stratified by the number of adverse events reported by patients showed a clear trend: the economic burden of adverse events increases with the number of adverse events reported,” Dr Hurvitz said. The study is the first to assess costs associated with adverse events during treatment for metastatic breast cancer.

Patients were selected from the PharMetrics Integrated Database, using pharmacy and medical claims from >100 US health plans, representing >70 million lives in the period between 2000 and 2010.

The eligible cohort included 3222 patients who used a taxane (ie, doce­taxel, paclitaxel) first-line, capecita­bine first-line, taxane second-line, or capecitabine second-line. Patients treated with both classes during the same episode were excluded. The list of adverse events included almost 2 dozen possibilities. Adverse events were seen in each of the 4 study cohorts.

Incremental Monthly Costs
The incremental costs associated with chemotherapy-related complications were estimated by comparing the average costs between the cohorts with and without adverse events for the 4 treatment groups:

  • Taxanes first-line: adverse events were associated with a 38.7% increase in monthly costs over patients without adverse events ($3547). These incremental costs were mainly driven by increased inpatient costs and other drug costs (other than those for chemotherapy)
  • Taxanes second-line: adverse events were associated with a 69.5% increase in monthly costs ($5320). Incremental costs were mainly driven by incremental pharmacy costs for chemo­therapy and other drugs
  • Capecitabine first-line: adverse events were associated with a 9% increase in monthly costs ($4933). Incremental costs were mainly driven by inpatient and outpatient costs
  • Capecitabine second-line: adverse events were associated with an 82.9% increase in monthly costs ($4933). Incremental costs were mainly driven by outpatient and inpatient costs.

Increasing Adverse Events per Episode Led to Higher Costs
The more adverse events per episode, the greater the cost of care, the analysis found. For example, for taxane first-line therapy, the mean cost of a treatment without an adverse event episode was approximately $10,000, which rose to approximately $11,000 in the setting of 1 or 2 adverse events, and to almost $15,000 in the setting of >4 adverse events.

For second-line capecitabine, treatment without an adverse event episode cost approximately $6000, but rose to approximately $14,000 in the setting of >4 adverse events.

The average monthly costs per type of adverse event were highest for skin toxicity with taxanes and for constitutional symptoms with capecita­bine, both approaching $16,000 on average.

“Further research evaluating the clinical and economic consequences of chemotherapy-related adverse events in a prospective manner can further characterize the effects seen here,” Dr Hurvitz concluded.
 

Related Items
MONALEESA-7 Sets New Standard of Care for Premenopausal Advanced Breast Cancer: Adding CDK4/6 to Endocrine Therapy Extends Survival
Phoebe Starr
August 2019, Vol 12, Special Issue: Payers’ Perspectives In Oncology: ASCO 2019 Highlights published on August 16, 2019 in Breast Cancer
FDA Expands Indication for Kadcyla to Include the Adjuvant Treatment of HER2-Positive Early Breast Cancer
Yvette Florio Lane
Web Exclusives published on May 14, 2019 in Breast Cancer, FDA Approvals, In the News
FDA Approves First Hormonal-Based Therapy for Men with Advanced or Metastatic Breast Cancer
Yvette Florio Lane
Web Exclusives published on April 5, 2019 in Breast Cancer, FDA Approvals, In the News
Proposed Landmark Policy Changes to Modernize Mammography and Raise Breast Density Awareness
Yvette Florio Lane
Web Exclusives published on April 1, 2019 in Breast Cancer, FDA Approvals, In the News
CAR T-Cell Therapy Yields Impressive Responses in Aggressive Non-Hodgkin Lymphoma
Chase Doyle
August 2018 Vol 11, Special Issue published on August 20, 2018 in Breast Cancer
Last modified: August 30, 2012
  •  Association for Value-Based Cancer Care
  • Oncology Practice Management
  • Value-Based Cancer Care
  • Value-Based Care in Rheumatology
  • Rheumatology Practice Management
  • Urology Practice Management
  • Lynx CME