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Abstract
BackgroundHealthcare resource utilization in breast cancer varies by disease characteristics and treatment choices. However, lack of clarity in guidelines can result in varied interpretation and heterogeneous treatment management and costs. In Europe, the extent of this variability is unclear. Therefore, evaluation of chemotherapy use and costs versus hormone therapy across Europe is needed.MethodsThis retrospective chart review (N = 355) examined primarily direct costs for chemotherapy versus hormone therapy in postmenopausal women with hormone-receptor–positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer across 5 European countries (France, Germany, The Netherlands, Belgium, and Sweden).ResultsTotal direct costs across the first 3 treatment lines were approximately €10 000 to €14 000 lower for an additional line of hormone therapy-based treatment versus switching to chemotherapy-based treatment. Direct cost difference between chemotherapy-based and hormone therapy-based regimens was approximately €1900 to €2500 per month. Chemotherapy-based regimens were associated with increased resource utilization (managing side effects; concomitant targeted therapy use; and increased frequencies of hospitalizations, provider visits, and monitoring tests). The proportion of patients taking sick leave doubled after switching from hormone therapy to chemotherapy.ConclusionsThese results suggest chemotherapy is associated with increased direct costs and potentially with increased indirect costs (lower productivity of working patients) versus hormone therapy in HR+, HER2– advanced breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1762-3) contains supplementary material, which is available to authorized users.
Highlights
Healthcare resource utilization in breast cancer varies by disease characteristics and treatment choices
The remaining 44 patient charts were excluded from the analysis because they did not meet the criteria for these 3 cohorts: 36 patients received only 1 therapy line in advanced breast cancer (ABC) and 8 patients received hormone therapy for 3 lines of treatment before switching to chemotherapy
The results demonstrated that total direct costs over the first 3 lines of therapy for HR+, HER2− ABC in postmenopausal women were €10 000 to €14 000 lower if a hormone therapy-based regimen was used for 1 additional line of therapy versus switching to chemotherapy
Summary
Healthcare resource utilization in breast cancer varies by disease characteristics and treatment choices. In advanced breast cancer (ABC), hormone therapy and chemotherapy are treatment options that have (to some extent) guideline-specific recommendations regarding initiation of use [5,6,7,8,9,10]. Guidelines for the sequence and preferred number of hormone therapy lines that can be used before switching to chemotherapy in ABC—outside of medical necessity—are not always clear [8, 9, 12]. This lack of clarity can result in varied interpretation of guidelines and can lead to heterogeneous treatment management and costs
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