Triple-Negative Breast Cancer Has Highest Hospitalizations, Mortality Rates

Charles Bankhead

February 2011, Vol 2, No 1 -

San Antonio, TX—Triple-negative breast cancer not only confers a worse prognosis but it drives up inpatient healthcare costs by almost 50% compared with other types of breast cancer, an analysis of a managed care database suggested.

Patients with triple-negative disease had a 2-fold greater mortality risk compared with other patients with breast cancer. The number of hospitalizations, hospital days, and emergency department visits also were significantly higher in patients with triplenegative disease.

“Triple-negative breast cancer patients experience significantly greater clinical burden compared with non– triple-negative breast cancer patients, especially in duration and costs of inpatient stays,” Wenhui Wei, PhD, health outcomes researcher at sanofi-aventis in Bridgewater, NJ, reported at the San Antonio Breast Cancer Symposium.

Triple-negative breast cancer—a subtype defined by absence of estrogen, progesterone, and HER2 receptors— exhibits aggressive biological and clinical behavior and has no standard therapy. The subtype accounts for about 15% of all breast cancer, but little is known about the inpatient and economic burden associated with triple-negative disease.

Investigators analyzed medical and pharmacy claims linked with mortality data from a large US managed care plan. They identified patients with new breast cancer diagnoses from 1999 to 2009 and separated the patients according to tumor receptor status. The final analysis comprised 450 patients with triple-negative breast cancer and 1807 patients with other breast cancer subtypes.

Patients were followed from diagnosis to the end of health plan enrollment or death. The primary outcomes were survival and healthcare utilization and costs. The analysis showed that triple-negative breast cancer, compared with other breast cancer subtypes, was associated with:

  • A relative risk of mortality of 2.34 for stages I to III (P <.001) and 1.60 for stage IV disease (P = .0148)
  • More hospitalizations (1.32 vs 0.97; P <.001), hospital days (10.98 vs 6.42; P <.001), and emergency department visits (1.30 vs 0.94; P = .029) per year
  • More cancer-related hospitalizations (0.65 vs 0.51; P = .002) and hospital days (4.64 vs 3.49; P = .047)
  • Greater risk-adjusted annualized inpa tient costs ($8395 vs $4745; P <.001) and plan-paid inpatient costs ($8213 vs $4486; P <.001)
  • Greater cancer-related risk-adjusted annual inpatient costs ($5070 vs $2675; P <.001) and plan-paid ($4844 vs $2533; P <.001).