Cumulative Financial Impact of Skeletal-Related Events on Patients with Breast Cancer Is Significant

Caroline Helwick

November 2012, Vol 3, No 8 - Economics of Cancer Care


?San Francisco, CA—In patients with breast cancer with bone metastases, skeletal-related events (SREs) are associated with high treatment costs. For example, the cumulative cost of treating 1 spinal cord compression exceeds $100,000, according to a new cost analysis presented at the 2012 Breast Cancer Symposium.

“Breast cancer patients with bone metastases are at risk for a variety of SREs. While a number of studies have described the impact of these SREs on cost, none has used an episode-of-care approach to examine the costs of unique SRE episodes in a typical clinical practice,” said May Hagiwara, PhD, Senior Economist, Policy Analy­sis Inc, Brookline, MA.

The data for this study came from the Thomson MedStat MarketScan Commercial Claims and Encounters database of patients treated between October 2002 and June 2011. Patients with breast cancer were included if they had confirmed bone metastasis and at least 1 diagnosis or procedure related to an SRE during the follow-up period (beginning with the index date and ending with disenrollment from the health plan).

Unique SRE episodes were identified based on a gap of at least 90 days without an SRE claim. Each SRE epi­sode was then classified by the type of the event—spinal cord compression, pathologic fracture, bone surgery, and bone radiotherapy.

Episodes were further classified as inpatient or outpatient. Treatment costs were calculated to calendar year 2010. The population included 5809 women who met the study criteria and had ≥1 SRE claims. Most of the women were insured through a preferred provider organization.

Cumulative Impact of Common SREs Is Costly
A total of 7617 SRE episodes were identified during a mean follow-up of 17.2 months, and included 113 (1.5%) spinal cord compression episodes, 1390 (18%) pathologic fracture epi­sodes, 191 (2.5%) bone surgery episodes, and 5923 (78%) radiotherapy episodes, Dr Hagiwara reported.

Spinal cord compressions were the most costly to treat, and pathologic fractures were the least costly. Bone surgery required involved an inpatient episode in 76% of patients compared with only 11% for those undergoing radiotherapy.

The mean per-episode cost for the 4 types of events was:

  • Outpatient pathologic fracture epi­sode: $10,700
  • Outpatient episode: $11,080
  • Inpatient episode: $55,229
  • Inpatient spinal cord compression episode: $102,205.

The costs, especially for spinal cord compression, appear high, and this is largely because such episodes may be multifactorial. Including all components of an episode gives a more realistic picture of the disease and of its high associated costs, Dr Hagiwara explained.

“Previous studies often looked, for example, at 1 inpatient admission, but the truth is that spinal cord compression may be preceded by a succession of other events,” noted Dr Hagiwara. “When you look at all events separately, you are not assessing the impact on the patient. Rather than look at a chunk here and a chunk there, we think this is probably the right way to assess this.”