BACKGROUND: In the past decade, many oncologic drugs have been approved that extend life and/or improve patients' quality of life. However, new cancer drugs are often associated with high price and increased medical spending. For example, in 2010, the average annual cost of care for breast cancer in the final stage of disease was reported to be $94,284, and the total estimated cost in the United States was $16.50 billion.

There is a paucity of health economic evaluations conducted from the patient's perspective in the literature. For those studies using the patient's perspective, the true patient costs were not fully explored and study reporting quality was not optimal. With the increasing focus on patient-centered outcomes in health policy research, more frequent use of the patient's perspective in economic studies should be advocated.

From both perspectives of the US payer and society, T-DM1 is not cost-effective when comparing to the LC combination therapy at a willingness-to-pay threshold of $150,000/QALY. T-DM1 might have a better chance to be cost-effective compared to capecitabine monotherapy from the US societal perspective.

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A221of SCT-ineligible patients; in second-line (post-onset of relapsed/refractory MM), lenalidomide/dexamethasone (33%) and bortezomib/dexamethasone (15%) were most common for patients previously receiving SCT (similar results reported for patients not receiving SCT). More than half of physicians estimated that typical second-line treatment duration is < 6 months, with progression cited (~75% of respondents) as the main reason for second-line discontinuation. For high-risk patients, 52% of physicians judged median survival to be < 10 months from RRMM onset. CONCLUSIONS: Bortezomib-based regimens are the predominant choice of first-line MM treatment; while bortezomib is also frequently chosen in second-line (post-RRMM onset), lenalidomide-based regimens are the most common. Survival prospects for RRMM patients remain limited, particularly for high-risk patients, and second-line therapy is typically of short duration (< 6 months). Patient-level studies are needed to formally characterize unmet medical needs suggested in our findings for European RRMM patients.OBJECTIVES: Initial endocrine therapy (ET) is preferred for most post-menopausal women with hormone receptor positive human epidermal growth factor receptor 2 negative metastatic breast cancer (HR+/HER2-mBC), and guidelines recommend reserving chemotherapy (CT) for patients with symptomatic visceral disease or no clinical benefit after 3 sequential ET regimens. This study describes treatment patterns among post-menopausal HR+/HER2-mBC patients previously treated with adjuvant therapy (recurrent patients) or not (de novo patients). METHODS: Charts from a network of US community-based oncology practices were reviewed for post-menopausal women with HR+/HER2-mBC who progressed to mBC between 1/1/2004 and 9/30/2010. Extracted chart data included demographic characteristics, treatment history, and outcomes. RESULTS: Patients (n= 144) had a median age of 65 years at mBC diagnosis. They received a median of 2 lines of ET, and < 10% had 3 or more lines of ET before receiving CT. De novo patients (n= 69) and recurrent patients (n= 75) received a median of 2 lines and 1 line of ET, respectively. The recurrent group had a lower proportion of patients receiving 1st-line single agent ET compared with the de novo group (65% vs. 71%). Unlike de novo patients, who had non-steroidal aromatase inhibitors (NSAIs) as the most frequent 1st-line ET (letrozole (35%), anastrozole (26%)), recurrent patients predominantly received fulvestrant (23%) in the 1st-line setting, possibly due to prior adjuvant NSAI. In addition, a higher proportion of recurrent patients received CT as 1st-line therapy compared with de novo patients (27% vs. 20%). CONCLUSIONS: The majority of de novo patients received 1st-line NSAIs, but recurrent patients were less likely to receive NSAIs and more likely to receive 1st-line CT. Recurrent patients also received fewer total lines of ET. Most mBC patients did not receive the guidelinerecommended 3 lines of ET. The unmet need for improved ET options was particular...