Abstract
PurposeWe sought to compare the economic impact of treatment-related adverse events (AEs) in patients with metastatic breast cancer (mBC) using taxane- or capecitabine-based treatment regimens as either first- or second-line (FL or SL) therapy in the US.MethodsWe used healthcare claims data from the Truven Health Analytics MarketScan® Commercial Databases to conduct a retrospective cohort study comparing the economic impact of AEs amongst taxane- and capecitabine-treated mBC patients in the US. We selected women diagnosed with mBC between 2008–2010 who received a taxane or capecitabine as first- or second-line (FL or SL) chemotherapy. Costs related to hospitalization, outpatient services, emergency department visits, chemotherapy and other medications were tabulated and combined to determine total healthcare costs. The incremental monthly costs associated with the presence of AEs compared to no AEs were estimated using generalized linear models, controlling for age and Charlson Comorbidity Index.ResultsWe identified 15,443 mBC patients meeting inclusion criteria. Adjusted total monthly costs were significantly higher in those who experienced AEs than in those without AEs in both lines of treatment (FL incremental cost: taxanes $1,142, capecitabine $1,817; SL incremental cost: taxanes $1,448, capecitabine $4,437). Total costs increased with the number of AEs and were primarily driven by increased hospitalization amongst those with AEs.ConclusionsAdverse events in taxane- or capecitabine-treated mBC patients are associated with significant increases in costs. Selecting treatment options associated with fewer AEs may reduce costs and improve outcomes in these patients.
Highlights
It is estimated that over 155,000 women are currently living with metastatic breast cancer in the United States (US) (Metastatic Breast Cancer Network 2010)
Treatment for metastatic breast cancer (mBC) is generally considered palliative in intent, and the primary goals are to prolong survival while improving symptoms and preserving quality of life (Beslija et al 2009)
We found that mean total monthly healthcare costs for mBC patients treated with a taxane or capecitabine ranged from $6,372 to $10,939, depending on the treatment cohort
Summary
It is estimated that over 155,000 women are currently living with metastatic breast cancer (mBC) in the United States (US) (Metastatic Breast Cancer Network 2010). The National Comprehensive Cancer Network Clinical Practice Guidelines (NCCN Guidelines) recommend various chemotherapeutic agents, used either as monotherapy or in combination, to prolong survival in patients with mBC (National Comprehensive Cancer Network 2013). Taxanes, such as paclitaxel and docetaxel, are commonly used. The NCCN guidelines list paclitaxel as a preferred single agent and docetaxel as an alternative single agent in the treatment of mBC (National Comprehensive Cancer Network 2013) Both of these agents are administered intravenously and may be used alone or as a part of a combination regimen. An earlier analysis investigating this issue used the PharMetrics® Integrated Database to analyze healthcare costs amongst patients with mBC receiving a taxane or capecitabine and found that chemotherapyrelated AEs were associated with a substantial economic burden, driven by increased inpatient, outpatient, and pharmacy costs (Hurvitz et al 2012)
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