A population-based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HE
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EPIDEMIOLOGY
A population‑based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HER2‑positive breast cancer Christine Brezden‑Masley1 · Kelly E. Fathers2 · Megan E. Coombes3 · Behin Pourmirza2 · Cloris Xue2 · Katarzyna J. Jerzak4 Received: 10 July 2020 / Accepted: 8 October 2020 © The Author(s) 2020
Abstract Purpose We sought to expand the currently limited, Canadian, population-based data on the characteristics, treatment pathways, and health care costs according to stage in patients with human epidermal growth factor receptor-2 positive (HER2+) breast cancer (BC). Methods We extracted data from the publicly funded health care system in Ontario. Baseline characteristics, treatment patterns, and health care costs were descriptively compared by cancer stage (I–III vs. IV) for adult women diagnosed with invasive HER2+ BC between 2012 and 2016. Resource use was multiplied by unit costs for publicly funded health care services to calculate costs. Results Overall, 4535 patients with stage I–III and 354 with stage IV HER2+ BC were identified. Most patients with stage I–III disease were treated with surgery (4372, 96.4%), with the majority having a lumpectomy, and 3521 (77.6%) received radiation. Neoadjuvant (NAT) and adjuvant (AT) systemic treatment rates were 20.1% (n = 920) and 88.8% (n = 3065), respectively. Systemic treatment was received by 311 patients (87.9%) with metastatic HER2+ BC, 264 of whom (84.9%) received trastuzumab. Annual health care costs per patient were nearly 3 times higher for stage IV vs. stage I–III HER2+ BC. Conclusion Per-patient annual costs were substantially higher for women with metastatic HER2+ BC, despite less frequent exposure to surgery and radiation compared to those with early stage disease. Increasing NAT rates in early stage disease represent a critical opportunity to prevent recurrence and reduce the costs associated with treating metastatic HER2+ BC. Keywords Breast neoplasms · Drug therapy · Epidemiologic studies · Health expenditures · Health services research · Receptor ErbB-2
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10549-020-05976-w) contains supplementary material, which is available to authorized users. * Katarzyna J. Jerzak [email protected] 1
Division of Medical Oncology and Hematology, Faculty of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
2
Department of Medical Affairs, Hoffmann-La Roche Limited, Mississauga, ON, Canada
3
Market Access and Pricing Department, Hoffmann-La Roche Limited, Mississauga, ON, Canada
4
Division of Medical Oncology and Hematology, Faculty of Medicine, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
Overall, human epidermal growth factor receptor-2 (HER2) positivity is seen in approximately 15–20% of breast carcinomas [1]. HER2-targeted therapy has revolutionized the treatment of HER2+ breast cancer (BC), and its use in the curat
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