Chemotherapy-Related Toxicity Adds to Economic Burden in Metastatic Breast Cancer
Chicago, IL—Adverse events (AEs) related to chemotherapy for metastatic breast cancer create 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 Can cer 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 the 2012 Ameri can Society of Clinical Oncology meeting.
“An analysis of healthcare costs stratified by the number of AEs reported by patients showed a clear trend: the economic burden of AEs increases with the number of AEs reported,” Dr Hurvitz said. The study is the first to assess costs associated with AEs 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 between 2000 and 2010.
The eligible cohort included 3222 patients who used a taxane (ie, doce – taxel, paclitaxel) first-line, capecita bine first-line, taxane second-line, or capecitabine second-line. Patients treated with both classes during the same episode were excluded. The list of AEs included almost 2 dozen possibilities. AEs 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 AEs for the 4 treatment groups:
- Taxanes first-line: AEs were associated with a 38.7% increase in monthly costs over patients without AEs ($3547). These incremental costs were mainly driven by increased inpatient costs and other drug costs (other than those for chemotherapy)
- Taxanes second-line: AEs were associated with a 69.5% increase in monthly costs ($5320). Incremental costs were mainly driven by incremental pharmacy costs for chemo – therapy and other drugs
- Capecitabine first-line: AEs were associated with a 9% increase in monthly costs ($4933). Incremental costs were mainly driven by inpatient and outpatient costs
- Capecitabine second-line: AEs were associated with an 82.9% increase in monthly costs ($4933). Incremental costs were mainly driven by outpatient and inpatient costs.
Increasing AEs per Episode Led to Higher Costs
The more AEs per episode, the greater the cost of care, the analysis found. For example, for taxane firstline therapy, the mean cost of a treatment without an AE episode was approximately $10,000, which rose to approximately $11,000 in the setting of 1 or 2 AEs, and to almost $15,000 in the setting of >4 AEs.
For second-line capecitabine, treatment without an AE episode cost approximately $6000, but rose to approximately $14,000 in the setting of >4 AEs.
The average monthly costs per type of AE were highest for skin toxicity with taxanes and for constitutional symptoms with capecita – bine, both approaching $16,000 on average.
“Further research evaluating the clinical and economic consequences of chemotherapy-related AEs in a prospective manner can further characterize the effects seen here,” Dr Hurvitz concluded.