Cost of disease progression among US patients with human epidermal growth factor receptor 2-positive metastatic breast cancer
Summary
Aim: The objectives were to investigate the differences in per patient per month (PPPM) healthcare resource utilization (HCRU) and costs among commercially insured and Medicare Advantage patients with human epidermal growth factor receptor 2 positive (HER2+) metastatic breast cancer (mBC) who experience disease progression in 12 months compared with those who don’t investigate the impact of progression timing on cumulative healthcare costs. Patients & methods: This claims-based study included patients diagnosed with mBC between 1 January 2013 and 30 April 2020 and received HER2-targeted therapy. Patients were categorized as progressed or nonprogressed. For objective one, monthly HCRU and costs were assessed for up to two lines of therapy (LOTs). Data were summarized descriptively and compared using a generalized linear model (GLM). For objective two, patients with at least 6 months of follow-up were assessed and cumulative healthcare costs were estimated in the 3 years following the start of LOT1 or LOT2 using a GLM and Kaplan–Meier weighting. Results: Among the 4113 patients in the study sample, 3406 had at least 12 months of follow-up (or less if due to death). Compared with nonprogressed patients, progressed patients had higher mean PPPM healthcare costs (LOT1: $22,014 vs $18,372, p < 0.001; LOT2: $19,643 vs $16,863, p = 0.001), and HCRU, including number of emergency room visits and inpatient stays (both p < 0.001) in the 12 months following LOT start. Progressed patients had higher 3-year mean cumulative healthcare costs than nonprogressed patients following LOT1 and LOT2 and this difference was greater for patients who progressed earlier. Conclusion: Disease progression was associated with significant increases in HCRU and costs. Delays in progression were associated with lower cumulative healthcare costs. Earlier use of more clinically effective treatments to delay progression may reduce the economic burden among these patients.
Plain language summary
What is this article about?
Patients with breast cancer whose cancer cells have a high level of a protein called HER2 (known as HER2+ breast cancer) tend to have more aggressive disease. We performed this research to better understand how delaying the growth or spread of HER2+ metastatic breast cancer affects patients’ healthcare resource utilization (HCRU) and costs. We used data from insurance claims to compare HCRU and costs between HER2+ metastatic breast cancer patients who did and did not progress within 12 months of starting therapy. We then investigated the impact of the timing of progression on healthcare costs. The groups were compared and analyzed using statistics and mathematical modeling.
What were the results?
In the 12 months following the start of treatment, HCRU and costs were higher for progressed patients compared with nonprogressed patients. Additionally, patients who progressed had higher total healthcare costs over the next 3 years than nonprogressed patients. The difference was bigger for patients who progressed earlier in treatment.
What do the results of the study mean?
Patients who progressed used more healthcare and had higher costs compared with those who did not. Treatments that delay disease progression could lead to less healthcare utilization and lower costs for these patients.