Economic burden related to chemotherapy-related adverse events in patients with metastatic breast cancer in an integrated health care system

Abstract

BackgroundBreast cancer is treated with many different modalities, including chemotherapy that can be given as a single agent or in combination. Patients often experience adverse events from chemotherapy during the cycles of treatment which can lead to economic burden.ObjectiveThe objective of this study was to evaluate costs related to chemotherapy-related adverse events in patients with metastatic breast cancer (mBC) in an integrated health care delivery system.MethodsPatients with mBC newly initiated on chemotherapy were identified and the first infusion was defined as the index date. Patients were ≥18 years old at time of index date, had at least 6 months of health plan membership and drug eligibility prior to their index date. The chemotherapy adverse events were identified after the index date and during first line of chemotherapy. Episodes of care (EOC) were created using healthcare visits. Chart review was conducted to establish whether the adverse events were related to chemotherapy. Costs were calculated for each visit, including medications related to the adverse events, and aggregated to calculate the total EOC cost.ResultsA total of 1,682 patients with mBC were identified after applying study criteria; 54% of these patients had one or more adverse events related to chemotherapy. After applying the EOC method, there were a total of 5,475 episodes (4,185 single episodes [76.4%] and 1,290 multiple episodes [23.6%]) related to chemotherapy-related adverse events. Within single episodes, hematological (1,387 EOC, 33.1%), musculoskeletal/pain related (1,070 EOC, 25.6%), and gastrointestinal (775 EOC, 18.5%) were the most frequent adverse events. Patients with adverse events related to single EOC with anemia and neutropenia had the highest total outpatient costs with 901 EOC ($81,991) and 187 EOC ($17,017); these patients also had highest total inpatient costs with 46 EOC ($542,798) and 16 EOC ($136,768). However, within multiple episodes, hematological (420 EOC, 32.6%), followed by infections/pyrexia (335 EOC, 25.9%) and gastrointestinal (278 EOC, 22.6%) were the most frequent adverse events.ConclusionThe economic burden related to chemotherapy adverse events in patients with mBC is substantial.

Burden of Oral Mucositis: A Systematic Review and Implications for Future Research

“…There were 7 studies covering 2 topics each [3,13,14,15,16,17,18] and 7 meta-analyses [19,20,21,22,23,24,25]. 20 studies (29.4%) were from Europe [3,5,9,10,11,12,15,22,26,27,28,29,30,31,32,33,34,35,36,37,38,] 20 from the US [4,14,17,19,20,24,39,40,41,42,43,44,45,46,47,48,49,50,51,52], 3 studies (4.4%) from US plus Europe [23,53,54], 6 studies (8.8%) from Japan [16,55,56,57,58,59], 6 studies (8.8%) from China [18,25,60,61,62,63], 2 studies (3.0%) from Hong Kong [13,64,65], 3 studies (4.4%) from Canada [66,67,68], 3 studies (4.4%) from India [21,69,70] and 5 studies (7.4%) from other countries [7,71,72,73,74]. 21 studies (30.9%) used the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) scale for assessment of OM.…”

“…Incidence of OM was investigated in patients with hematopoietic stem cell transplantation (HSCT) in 14 studies (32.6%) [3,5,14,17,19,28,31,36,37,39,44,56,62,67], in head and neck cancer (HNC) patients in 13 studies (30.2%) [18,21,29,40,50,51,55,59,60,61,63,70,73], in patients with chemotherapy in 13 studies (30.2%) [15,16,22,23,24,25,30,34,38,46,48,58,71], with mixed tumor types and treatment in 1 study (2.3%) [13] and with palliative care in 2 studies (4.7%) [32,57]. Cost related to OM in patients undergoing HSCT was the focus in 4 studies [7,14,17,54], in HNC patients in 2 studies [43,47], in patients with chemotherapy in 6 studies [9,10,11,12,42,49,68], and in patients with mixed tumor types and treatment in 2 studies [20,45]. Resource use associated with OM was reported in 3 studies concerning patients with HSCT [3,7,17], 2 studies with HNC [4,43] and 1 study with chemotherapy [42] and 1 study with mixed tumor types and treatment [45].…”

“…In patients with chemotherapy for solid tumors, 1 US study described incremental costs for OM grade < 3 of USD2,725 and for OM grade ≥ 3 of USD5,565 per chemotherapy cycle from the payer perspective [42]. Single episodes of stomatitis in breast cancer patients receiving chemotherapy can amount to USD4,630 when hospitalization is necessary and multiple episodes to USD8,349 per episode including cost for hospitalization and emergency room [49]. German piggy-back analyses give costs for OM grade ≥ 3 between USD345 [9,12] and USD1,896 [11], and hospitalization costs of USD2,231 [10] from the payer perspective.…”

“…The 3 most recent studies with information on cost associated with OM were 2 database analyses on women with chemotherapy for breast cancer from United States and Canada [49,68] and 1 single-center study from Brazil on patients with HSCT [7]. Due to different healthcare systems and patient groups, the data are not comparable.…”

Patient recommendations for reducing long‐lasting economic burden after breast cancer

“…1 In the United States, patients who have breast cancer experience significant economic burden, even compared with those who have other types of cancer. [4][5][6][7][8] The economic burden after cancer may be further exacerbated for patients who are managing adverse treatment effects, [9][10][11][12][13][14] such as breast cancer-related lymphedema, 15,16 which is one of the most common and costly breast cancerrelated adverse treatment effects, affecting nearly 35% of breast cancer survivors in the United States 17,18 and resulting in an estimated $14,877 in out-of-pocket costs in the first 2 years of a diagnosis. 15 Even up to 10 years after diagnosis, outof-pocket health costs for women who have breast cancer-related lymphedema are more than double the costs for those without breast cancer-related lymphedema.…”