Current Patterns and Costs of Treating Patients with Metastatic Breast Cancer
San Francisco, CA—In a population of patients with metastatic breast cancer and Medicare Part D claims, the mean lifetime cost of treatment was approximately $102,000, according to a study presented at the 2013 Breast Cancer Symposium by Hope S. Rugo, MD, Director, Breast Oncology Clinical Trials Program, University of California, San Francisco.
The injectable endocrine agent fulvestrant (Faslodex) was the most frequently used first- and second-line therapy, and anastrozole (Arimidex) was the second choice; in the third-line setting, fulvestrant and anastrozole were equally used.
Metastatic breast cancer treatment is costly, requiring systemic therapy that often includes combinations of chemotherapies, hormonal therapies, and molecular targeted therapies. A previous analysis of the Surveillance, Epidemiology and End Results (SEER)-Medicare database from 2001 to 2008 showed that fulvestrant was the most common first-line agent, vinorelbine (Navelbine) was used most in the second line, and trastuzumab (Herceptin) was the preferred third-line agent, but that analysis did not include Part D claims; therefore, oral therapies were not included.
The current study updates the previous analysis with data through 2009, and examines patterns of care and associated costs in a subgroup of women with Part D enrollment.
“The inclusion of Part D claims provides increased understanding of treatment patterns and costs among patients with metastatic breast cancer,” Dr Rugo noted.
The SEER-Medicare database includes linked data from 2001 to 2007 SEER cancer registries and 2001 to 2009 Medicare enrollment and claims files. Along with examining these data, the investigators also calculated healthcare costs, including those related to inpatient and outpatient care, skilled nursing facility stays, home healthcare, and durable medical equipment.
The cost of injectable agents was included as part of inpatient and outpatient costs. The cost of oral medications was not included in total costs.
There were 7905 patients with metastatic breast cancer identified, and 773 had Medicare Part D coverage. In the overall sample, first-line therapy was identified for 82% of patients, of whom 48% went on to receive second-line treatment, and 26% received third-line therapies. Fulvestrant was the most common first-line therapy, received by 19% of patients on first-line treatment, and vinorelbine was the most common second-line (18%) and third-line (16%) drug. The total mean per-patient cost was $127,000, which was higher than the $113,000 determined from the previous analysis from 2001 to 2007.
Part D Subgroup
For the subgroup of 681 patients with Part D coverage and a diagnosis of metastatic breast cancer in 2007, first-line therapy was identified for 88% of patients. Of those receiving first-line therapy, 63% went on to receive second-line treatment and 45% had a third-line drug. For this group, fulvestrant was the most common first-line and second-line therapy, and anastrozole was the second most common in both of these settings, with letrozole third. In the third line, anastrozole and fulvestrant were used equally. In all settings, tamoxifen was infrequently used.
The mean lifetime healthcare cost for the patients with Part D benefits was $102,000 overall, nearly $70,000 of which were physician and hospital costs. By line of therapy (Table), the costliest drug in the first-line setting was anastrozole ($103,277), and vinorelbine was most expensive in the second-line ($155,000) and third-line ($134,475) settings.