Utilization and relative value of breast cancer adjuvant chemotherapy regimens in the community.

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e16595 Background: Selection of adjuvant breast cancer (BC) therapy varies based on patient risk factors. Utilization and choice of chemotherapy (CT), schedule, duration, and supportive care affects costs. We aimed to characterize neoadjuvant/adjuvant (N/Ad) CT utilization by tumor type and regimen (R) type, and estimate associated costs. Methods: Using the US Oncology iKnowMed EHR database, we retrospectively identified female BC patients (pts) diagnosed with stage I-III BC, between 7/2006 and 11/2010. Secondary diagnoses were excluded. Pts were characterized by age, ER and HER2 status, tumor size, grade, and nodes. CT utilization was determined by the number of pts assigned an N/Ad line of therapy (LOT) during the study period. Rs were categorized by CT title and drugs. Clinical trial pts were included. Incomplete, changed, and non-standard Rs were categorized as ‘other’. Medicare allowable was used for CT costs (using 70 kg or 1.7m2). Office visit (OV) and lab costs were added to each CT administration excluding trastuzumab maintenance. Results: During the time period, 40,881 BC pts were identified. An N/Ad LOT was documented in 37% of pts. CT utilization was 65% in HER2+ pts, 60% in ER-/HER2- pts, and 29% in ER+/HER2- pts. Other subsets were also characterized. TC (docetaxel/cyclophosphamide) then AC-paclitaxel like regimens were the most used HER2- regimens. TCH (docetaxel/carboplatin/trastuzumab) then AC-TH (paclitaxel/trastuzumab) were the most used HER2+ regimens. The table shows utilization and estimated costs. Conclusions: CT is a driver of cost. Nonanthracycline regimens are highly utilized in the community for N/Ad BC treatment. Use of docetaxel, trastuzumab, and pegfilgrastim increased treatment costs. Utilization and costs of select regimens. Utilization (%) Regimens ER+/HER2- ER-/HER2- Estimated total cost* ($) HER2- AC x 4 6 7 1,153 AC x 4 - docetaxel x 4 2 2 14,328 AC x 4 - paclitaxel weekly x 12 19 27 3,520 CMF x 6 1 1 1,518 FEC x 6 <1 <1 2,219 TC x 4 37 26 10,411 TAC x 6 16 13 31,009 Other 11 16 Clinical trial 8 8 HER2+ Any HER2+ AC x 4 - paclitaxel weekly x 12 + H x 1 yr 14 55,201 TCH x 6 - H x 1 yr 37 67,076 Other 39 Clinical trial 10 * CT Medicare allowable 1Q2011 + level 5 established OV and CBC and CMP per dose. Includes pegfilgrastim.