Treatments vary widely for metastatic breast cancer patients, and it might be expected then that costs to treat these patients also vary considerably. An analysis presented at the American Society of Clinical Oncology Breast Cancer Symposium in San Francisco, though, suggests that costs per patient are relatively similar across a number of different treatments.
“Overall costs for all medical care . . . from the time of diagnosis were $113,000 per patient, the bulk of that being physician fees, inpatient fees, and outpatient fees,” said Douglas Taylor, MBA, director of health economics and outcomes research at Optuminsight, in a presentation at the symposium. Mr. Taylor and colleagues used data from the Surveillance Epidemiology and End Results (SEER) database in combination with Medicare data to analyze treatment patterns and associated costs in women with metastatic breast cancer. The SEER database represents about 28% of the US population.
The study included 5,805 patients with a mean age of 74 years and followed up for 21.5 months. Patients were either entered into the database with an initial diagnosis of metastatic disease, or were identified as having metastatic breast cancer during the follow-up period. The majority of patients fell into the latter group; for example, in 2001 there were 84 patients included with an initial metastatic diagnosis, and 471 diagnosed after already being included in the database. In 2005, the largest year for inclusion in the study, these numbers were 119 and 1,277, respectively.
The researchers could identify the first-line therapy in 4,763 patients (82%); of these, they identified second-line therapy in 38% and third-line in 24%. “There were dozens of unique regimens,” Mr. Taylor said, but fulvestrant was the most commonly used first-line therapy, followed by taxane. For second-line therapies, vinorelbine was most commonly used, followed by taxane and fulvestrant. Trastuzumab was most common as a third-line treatment, followed by vinorelbine and gemcitabine.
As Mr. Taylor said, the overall costs were $113,000 per patient. Of that total amount, $46,000 was in physician fees, followed by $32,000 in hospital fees, $20,000 in outpatient fees, and less than $10,000 each for hospice care and other categories.
“The most expensive patients were treated with trastuzumab,” Mr. Taylor said, but noted that especially after starting second-line therapy the costs were fairly stable across the treatment options. Among first-line therapies, trastuzumab-treated patients had an overall cost of $145,000, compared with $113,000 for fulvestrant-treated patients and $103,000 for taxane-treated patients.
He noted that the patients in this study may not be representative of all metastatic breast cancer patients in the United States, especially given the inclusion of Medicare data; as a result, 90% of patients in the study were over 65 years of age. Also importantly, pharmacy data on oral medications, such as most hormone therapies, capecitabine, and others, were not available to the researchers.