Abstract P3-06-07: All-cause costs among elderly breast cancer patients by receipt of human epidermal growth factor receptor 2-targeted therapy: An analysis of US national data 2006-2009

Abstract

Abstract BACKGROUND: There are few recent studies of all-cause costs among elderly, newly diagnosed breast cancer (BC) patients by receipt of human epidermal growth factor receptor 2- (HER2-) targeted therapy. METHODS: Using linked Surveillance, Epidemiology, and End Results (SEER) and Medicare claims and enrollment data from 2006-2009, women aged 65+ years with an incident diagnosis of BC (index date) in 2007 and no prior history of any other cancer were identified and followed to evaluate all-cause costs. Study patients were required to have continuous enrollment from 1 year before index (baseline period) through the end of the data window, disenrollment or death, whichever came first. Patients were classified as having received HER2-targeted therapy if they had any claim indicating trastuzumab or lapatinib following diagnosis. Costs (including costs of hospitalizations, outpatient visits, physician/provider services, prescription drug, skilled nursing facility [SNF] care, home health care, hospice care, and durable medical equipment [DME]) were evaluated per-patient-per-month (PPPM) by receipt of HER2-targeted therapy (and by age and stage among those receiving HER2-targeted therapy). RESULTS: Among 11,238 female BC patients, 510 received HER2-targeted therapy (99.8% trastuzumab, 2.5% lapatinib) and 10,728 did not. Mean total PPPM costs were significantly higher for patients treated with HER2-targeted therapy ($5,380 vs. $2,777, P<0.01), driven by differences in outpatient care ($1,261 vs. $468, P<0.01) and physician/provider services ($2,893 vs. $900, P<0.01). Mean PPPM prescription drug ($248 vs. $238, P = 0.11), SNF ($121 vs. $182, P = 0.78), and hospice ($49 vs. $83, P = 0.99) costs were similar between the two groups, while inpatient costs were slightly lower for patients treated with HER2-targeted therapy ($680 vs. $793, P<0.01). Among patients treated with HER2-targeted therapy, mean total PPPM costs were similar across age groups ($5,426 [65-69], $5,093 [70-74], $5,655 [75+]; P = 0.38), although older patients experienced significantly higher costs for less expensive components including inpatient ($644, $573, $839; P = 0.02), SNF ($92, $57, $223; P<0.01), home health ($60, $61, $144; P<0.01), and hospice ($25, $16, $114; P<0.01) care. Total PPPM costs were higher for patients in later stages ($4,646 [Stage I], $4,755 [Stage II], $5,893 [Stage III], $7,685 [Stage IV]; P<0.01), as were PPPM inpatient ($487, $553, $895, $1,105; P<0.01), outpatient ($1,257, $1,080, $1,407, $1,804; P<0.01), physician/provider services ($2,587, $2,658, $2,912, $3,887; P<0.05), SNF ($38, $116, $152, $253; P<0.01), home health ($33, $63, $118, $197; P<0.01), DME ($18, $31, $52, $83; P<0.01), and hospice ($0, $4, $54, $164; P<0.01) costs. CONCLUSIONS: Patients receiving HER2-targeted therapy had higher total costs than those not receiving HER2-targeted therapy, driven by higher costs of outpatient care and physician/provider services. Inpatient costs were slightly lower for patients receiving HER2-targeted therapy. Among patients with HER2-targeted therapy, costs were higher for patients in later stages. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-07.