Trends in trastuzumab utilization in Ontario: A single payer system

Abstract

11534 Background: Ontario, a province of 13 million, has a single payer system for new IV cancer drugs, the New Drug Funding Program (NDFP) of Cancer Care Ontario. Trastuzumab (T) is an NDFP drug with funding for both adjuvant (adj) and metastatic (met) breast cancer. Each patient (pt) is registered as adj, or met with line of treatment (tx). Adj T is funded for pts who receive adj chemotherapy (chemo) for node+ disease or node-, >1cm. Methods: Pts who received T were identified in the NDFP from 1999–2007. Funding for met disease was from 1999 onwards and for adj tx from 7/2005 (tx allowed for those whose adj chemo ended after 10/2004). For adj T, records of further chemo were identified for pts treated in Integrated Cancer Programs, for whom complete tx information is available, 50% of all adj pts. Results: About 5,300 cases of breast cancer are diagnosed annually in ON. 1,799 patients have received met T since 1999. Initially met tx was 1st, 2nd and 3rd line, including single agent T. Since 2005 tx is more likely to be 1st line with a taxane or vinorelbine. Median duration of tx with docetaxel (D) is 7 mos, range <1 mo –28.2 mos. Since 2005, 2,217 pts have received adj T. Of these, 866 pts have complete records available and completed adj T by the end of 10/2007. Only 19 have received further chemo for mets. At most 50% of relapses would receive either no tx or hormonal tx, so we estimate that 38/886 or 4.3% of pts have relapsed after adj T. Currently, 100 pts/mo are enrolled in the NDPF, 80 for adj T and 20 for met T. Conclusions: In Ontario 960/5,300 or 18% of pts receive adj T and chemo annually. Relapses have been very infrequent (<5%) after adj T to date. In the met setting most T is given in combination with D, with a median duration of use of 7 mos. No significant financial relationships to disclose.