Neil M. Schultz, PharmD, MS
Healthcare resource use and costs remain high among patients with metastatic triple-negative breast cancer (mTNBC), indicating a need for better targeted treatments for this patient class, according to a retrospective 4.5-year study of patients who had commercial and Medicare supplemental coverage.
There is scant research on costs and utilization for mTNBC, but physicians know firsthand about the cost burden of treating patients with mTNBC, said lead researcher Neil M. Schultz, PharmD, MS, of Astellas Pharma Global Development. “What this data show is that hospitalization and infusion costs inside the outpatient setting are significant cost drivers for mTNBC patients.” A poster presentation of the study was presented at the 2017 Miami Breast Cancer Conference®
“When we analyzed the total monthly spend on mTNBC patients, over half of the costs were attributed to outpatient infusion; another 30% to 35% came from inpatient hospital stays—even the agents women are being treated with are sometimes putting them into the hospital due to adverse events. That was the biggest finding from a cost perspective,” Schultz said.
Patients in the study were seen in oncology practices from January 1, 2011 through June 30, 2015, and they represented a mix of newly diagnosed patients and patients with a history of mTNBC. The data was culled from the MarketScan Oncology Claims-EMR Linked Database.
The study encompassed 163 female patients of a mean age of 55.1 years and charted their resource utilization for an average period of 569.3 days. Among patients with mTNBC on treatment during follow-up, 76% had chemotherapy: cyclophosphamide (60%), paclitaxel (56%), doxorubicin (52%), carboplatin (25%), docetaxel (23%), gemcitabine (19%), and capecitabine (4%) were the most common first-line chemotherapy treatments administered in >10% of the population. Among mTNBC patients who received targeted therapy (<7%), the most common therapy was bevacizumab (4%).
Lengthy hospital stays lasting up to a week were common: 47.2% of patients with mTNBC had at least 1 disease-related inpatient admission, and 32.5% of patients had at least 1 emergency department (ED) visit. The researchers reported that mTNBC inpatient admissions averaged 6.5 days in length. In addition, use of outpatient physician office visits and other outpatient services for mTNBC was common among all subjects (98.2% for both services). Other outpatient services primarily included infusion services, but also some laboratory and radiology services. Patients averaged 9.6 visits per month for mTNBC-related other outpatient services, which primarily included chemotherapy infusion.
Total healthcare costs per person, per month (PPPM) were $7643. This broke down as follows: $5013 for chemotherapy infusion, laboratory/radiology, and other outpatient services (65% of total PPPM cost); $2321 for mTNBC related inpatient admissions (30.4%); $309 for outpatient office visits, pharmacy prescriptions, and ED visits (4%).
Patients eligible for inclusion in the study were required to have commercial health coverage or private Medicare supplemental coverage, and the researchers noted that results may not be generalizable to the entire US population. However, despite the small patient sample the findings should be concerning, Schultz said. “This provides some real cost data with respect to medical and pharmacy on a per-patient, per-month basis. The objective of this analysis was to look at those in the metastatic state, because there’s very little contemporary data on real-world costs.”
Schultz NM, Kaklamani VG, Irwin DE, et al. Healthcare resource utilization and costs of care among patients with metastatic triple-negative breast cancer. Poster presented at 34th Annual Miami Breast Cancer Conference®; March 9, 2017; Miami, FL.<<< View more from the 2017 Miami Breast Cancer Conference