A population-based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patient
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EPIDEMIOLOGY
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 Christine Brezden‑Masley1 · Kelly E. Fathers2 · Megan E. Coombes3 · Behin Pourmirza2 · Cloris Xue2 · Katarzyna J. Jerzak4 Received: 10 July 2020 / Accepted: 28 September 2020 © The Author(s) 2020
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. Keywords Cohort studies · Drug therapy · Health services research · Radiotherapy · Receptors steroid · Surgical procedures operative · Breast neoplasms Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10549-020-05960-4) 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
Introduction Breast cancer (BC) is a heterogenous disease that can be defined by morphologic or molecular features that predict a patient’s prognosis. One of the most clinically driven classification s
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