Cost of Treatment in Metastatic Breast Cancer Increasing Significantly with End-of-Life Hospitalizations

Kate O’Rourke

September 2014, Vol 5, No 7 - Economics of Cancer Care

Tampa, FL—Patients with HER2-positive metastatic breast cancer consume 2.5 times more financial resources in their last 6 months of life, according to study results presented at the 2014 Academy of Managed Care Pharmacy meeting. The study focused on real world healthcare resource utilization and costs of patients with HER2- positive metastatic breast cancer who received trastuzumab (Herceptin) near the end of life.

This retrospective, observational review gathered claims data from the IMS LifeLink Health Plan Claims Database between January 1, 2002, and June 30, 2012. Patients were excluded if they received lapatinib (Tykerb) for first- or second-line therapy. (IMS LifeLink is a comprehensive database of integrated medical and pharmacy claims from more than 79 US health plans, for approximately 87 million deidentified lives.)

The study included 2 cohorts—patients who were alive at the end of the 6-month follow-up (N = 670) and those who were not (N = 196).

The costs were based on the allowed amount on the claims (adjusted for inflation to 2012 US dollars). The mean 6-month total healthcare cost was 2.54 times higher in patients who died than in patients who were still alive—$69,426 versus $26,857, respectively (95% confidence interval, 2.06-3.13; P ‹.001). The costs were significantly higher for those who died during the 6-month follow-up in each care component measured, including hospital inpatient, hospice, emergency department, physician office, other outpatient, home health/durable medical equipment, and pharmacy.

In the cohort of patients who died, there was a 20-fold increase in inpatient costs and a 14-fold increase in hospice costs between the sixth and first months before the end of life.

“The main driver of higher costs during those 2 last months is hospitalization,” lead investigator of the study Thomas J. Bramley, RPh, PhD, Senior Vice President, Scientific Consulting, Xcenda, told Value-Based Cancer Care.

In the cohort of patients who were still alive at 6 months, the monthly costs were similar throughout the study. The researchers cautioned that results cannot be generalized to patients who were not commercially insured or who had HER2-negative breast cancer.

Amy P. Abernethy, MD, PhD, Palliative Medical Specialist, Director, Duke Cancer Care Research Program, who was not involved with the study, said that the finding that healthcare, especially inpatient care and hospice costs, is more expensive in the last 6 months of life is consistent with other studies and what is expected.

As people get sicker, they need more healthcare, including treatments for cancer and hospitalizations, Dr Abernethy told Value-Based Cancer Care. Hospice care, which helps keep people out of hospitals, increased in the last 6 months, potentially lowering some of the inpatient costs. She pointed out that the study did not provide information on whether the treatments that were provided made “good sense.”

“Part of the problem is that it is really hard to figure out who is going to die and who needs a shift to a hospice focus and when. We can’t say whether or not there is any signal [in this study] that these women should not have been getting therapy, because we don’t actually have a sense of how sick they were at the time of treatment,” Dr Abernethy pointed out. “The number one take-home message is that we have to get better at figuring out where people are on the curve of prognosis, so that we can help them make good decisions.”