A population-based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with hormone receptor-positive/HER2-negative breast cancer

Abstract

Purpose To update and expand on data related to treatment, resource utilization, and costs by cancer stage in Canadian patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) breast cancer (BC). Methods We analyzed data for adult women diagnosed with invasive HR+/HER2− BC between 2012 and 2016 utilizing the publicly funded health care system in Ontario. Baseline characteristics, treatment received, and health care use were descriptively compared by cancer stage (I–III vs. IV). Resource use was multiplied by unit costs for publicly funded health care services to calculate costs. Results Our study included 21,360 patients with stage I–III plus 813 with stage IV HR+/HER2− BC. Surgery was performed on 20,510 patients with stage I–III disease (96.0%), with the majority having a lumpectomy, and radiation was received by 15,934 (74.6%). Few (n = 1601, 7.8%) received neoadjuvant and most (n = 15,655, 76.3%) received adjuvant systemic treatment. Seven hundred and fifty eight patients with metastatic disease (93.2%) received systemic therapy; 542 (66.7%) received endocrine therapy. Annual per patient health care costs were three times higher in the stage IV vs. stage I–III cohort with inpatient hospital services representing nearly 40% of total costs. Conclusion The costs associated with metastatic HR+/HER2− BC reflect a significant disease burden. Low endocrine treatment rates captured by the publicly funded system suggest guideline non-adherence or that a fair portion of Ontarian patients may be incurring out-of-pocket drug costs.

Real-World Treatment Patterns, Clinical Outcomes, Healthcare Resource Utilization, and Costs in Advanced Hepatocellular Carcinoma in Ontario, Canada

“…Previous studies have demonstrated that evaluating real-world data (RWD) is valuable for analyzing HCC with various applications [ 16 , 20 , 21 ]. ICES data have been used extensively to assess treatment patterns, healthcare resource utilization (HCRU), prevalence, and survival outcomes across multiple tumor areas in Ontario, Canada [ 22 , 23 , 24 , 25 ]. Population-level estimates yielded from our analysis may be of great interest for clinicians to enhance the understanding of the clinical outcomes of aHCC patients under the current treatment landscape and for healthcare decision makers, providing them with information about the economic impacts of different therapeutic options [ 21 , 26 , 27 ].…”

Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing

“…Two-year costs from 2005 to 2009 in Ontario were (2012C$) C$ 29,938, C$ 46,893, C$ 65,369 and C$ 66,627 for stages I to IV, respectively [ 53 ]. Two recent studies considered the cost of treating ER+ and TN BC in Ontario based on cases from 2012 to 2016 [ 6 , 55 ]. The average annual per-patient treatment costs from these studies were (2017C$) C$ 22,662 (HR+) and C$ 35,064 (TN) for stage I–III and C$ 77,112 (HR+) and C$ 140,160 (TN) for stage IV; however, only 17% of patients with stage IV BC received CDK 4/6 inhibitors.…”

“…Gross costing uses publicly available population-level data with aggregated costs, providing a system-level perspective, but may not capture indirect costs, privately paid drugs and treatment preferences when there are multiple therapeutic pathways [ 5 ]. Importantly, lags in data availability create delays in gross costing, such as in BC, where a 2021 study reported costs only from 2016 [ 6 ]. In the setting of BC, where treatments are rapidly evolving, any delay in informing costs limits the current applicability of such models.…”

The Impact of Organised Screening Programs on Breast Cancer Stage at Diagnosis for Canadian Women Aged 40–49 and 50–59

“…In Ontario in 2014, the two-year treatment costs for stage I through IV BC were CAD 29,938; CAD 46,893; CAD 65,369, and CAD 66,627, respectively [ 57 ]. The treatment of hormone receptor-positive (HR+)/human epidermal growth factor 2 negative (HER2-) metastatic disease in Ontario from 2012 to 2017 cost more than CAD 1.2 billion [ 58 ]. These costs likely underestimate the current financial impacts of treating advanced BC.…”